US · guidance
CMS Pub. 100-16, ch. 7, § 70.3
End Stage Renal Disease (ESRD)
In addition to the CMS-HCC model used to improve payment accuracy for aged/disabled
beneficiaries enrolled in MA plans and PACE organizations, CMS implemented the
ESRD model to improve accuracy for enrollees with ESRD, including those in dialysis
status, having transplants, and in post-graft status. The CMS-HCC ESRD model is based
on the CMS-HCC model for aged/disabled beneficiaries: it uses the same HCCs and
therefore retains the characteristics of the CMS-HCC model. The coefficients differ as
they are estimated for the ESRD dialysis and transplant populations, which have different
costs for their Part A and B benefits and different cost patterns among the various
diagnoses.
The following are the segments of the ESRD model:
• Dialysis,
• Transplant, and
• Post-Graft/Functioning Graft
History
(Rev. 114, Issued; 06-07-13, Effective: 06- 07-13, Implementation: 06-07-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ebee67db142e3744dc2df7962f38e9ca599b23286cbe58a75280bbd1f746b9a4
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