Navigate Shifting Reimbursement Criteria for Molecular Testing
At TELCOR, we’ve recently identified a notable shift in how molecular claims specifically associated with CPT code 87798, are being processed by...
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The Centers for Medicare & Medicaid Services recently updated the payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS).
The final rule, issued on Nov. 20, will increase the ESRD PPS base rate to $281.71 in calendar year (CY) 2026 (an increase of $7.89 from CY 2025), which is projected to increase total payments to all ESRD facilities (freestanding and hospital-based) by about 2.2 percent. There will also be a payment adjustment for certain nonlabor costs in ESRD facilities in Alaska, Hawaii, and the U.S. Pacific Territories.
Additionally, the rule updates the acute kidney injury dialysis payment rate for renal dialysis services furnished by ESRD facilities for CY 2026 and the requirements for the ESRD Quality Incentive Program (QIP).
Finally, the rule shortens the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems survey to 39 questions, removing 23; eliminates three health equity reporting measures from the ESRD QIP; and finalizes the early termination of the ESRD Treatment Choices Model.
These changes apply to renal dialysis services furnished to Medicare beneficiaries on or after Jan. 1, 2026.
Source:
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