ESRD PPS Facility-Level Adjustments
Guidance for facility-level payment adjustments to End Stage Renal Disease facilities for renal dialysis services.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 15, 2019
ESRD PPS facility-level adjustments include the following:
Wage Index:
An adjustment that reflects urban and rural differences in area wage levels using an area wage index developed from Core-Based Statistical Areas (CBSA).
Low Volume:
An adjustment for facilities that furnish a low volume of dialysis treatments. To receive the low-volume adjustment, the facility must submit an attestation to the Medicare Administrative Contractor (MAC) no later than November 1, prior to the calendar year (CY) in which the adjustment would be effective.
Rural:
A payment adjustment for ESRD facilities located in rural areas.
Note: Claims for pediatric patients are not eligible for the low-volume or rural adjustments.
Training Add-On:
Certified training facilities receive the wage adjusted training add-on payment to account for nursing time for each training treatment that is furnished. This adjustment applies to both peritoneal dialysis (PD) and hemodialysis (HD) training treatments.
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.