US · guidance
CMS Pub. 100-04, ch. 8, § 10.4
Deductible and Coinsurance
The beneficiary is responsible for any unmet deductible and for coinsurance.
Eighty percent of the total End Stage Renal Disease Prospective Payment System (ESRD
PPS) payment amount for renal dialysis services furnished by ESRD facilities to ESRD
beneficiaries is paid by Medicare. ESRD beneficiaries are responsible for the remaining
twenty percent after the deductible. Therefore, the beneficiary coinsurance amount under
the ESRD PPS is twenty percent of the total ESRD PPS payment, which includes the
ESRD PPS base rate, all applicable adjustments, any applicable training add-on amounts
and any applicable outlier payments.
History
(Rev. 10640, Issued:08-06-21, Effective:09-07-21, Implementation:09-07-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
0d7b115d7a8d208ca4cbc39c2ade49f1e9d599f03ca6ffe00afb1aebd393c44f
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