If you or someone you love needs dialysis, the cost question is urgent. Without insurance, a single in-center hemodialysis session runs $500 to $1,000 or more. Three sessions a week adds up to $78,000 to $120,000 per year. Most people cannot pay that out of pocket. The good news: Medicare covers dialysis for almost every American with end-stage renal disease (ESRD), regardless of age, and the 2026 bundled payment system is designed to limit surprise billing. But the details matter, and billing errors on dialysis statements are common.
Quick Answer: In 2026, Medicare pays dialysis facilities a bundled rate of $281.71 per session, covering drugs, labs, supplies, and equipment. Patients with Medicare pay 20% coinsurance after the Part B deductible. Without any insurance, in-center dialysis costs $500 to $1,000 per session. CPT code 90999 is the unlisted dialysis billing code used when no specific code exists for a service. It has no set rate and must be documented carefully.
What Dialysis Actually Costs in 2026
The sticker price for dialysis depends on three variables: where you get treatment, what type of dialysis you need, and who is paying.
In-Center Hemodialysis
In-center hemodialysis is the most common type. Patients go to a dialysis center three times per week for 3 to 4 hours per session. The self-pay rate per session ranges from $500 to $1,000 depending on the facility and location. At 156 sessions per year, annual costs reach $78,000 to $156,000 without insurance or financial assistance.
Peritoneal Dialysis (Home)
Peritoneal dialysis (PD) happens at home and costs less overall. Annual costs for PD run approximately $53,000 when self-pay, compared to roughly $78,000 for in-center hemodialysis. PD uses a catheter and dialysis solution to filter waste through the lining of your abdomen, and patients typically do it every night or several times daily.
Home Hemodialysis
Home hemodialysis (HHD) requires purchasing or leasing a dialysis machine ($26,000 to $47,000 for equipment alone) plus installation of water and waste lines ($750 to $1,500). Annual treatment costs for HHD are roughly $60,000 when self-pay. Equipment costs make the upfront investment steep, but ongoing per-session costs are lower than in-center care.
2026 Dialysis Cost Comparison by Type
| Dialysis Type | Estimated Annual Cost (No Insurance) | Sessions Per Week | Setting |
|---|
| In-center hemodialysis | $78,000 to $156,000 | 3x per week | Dialysis center |
| Peritoneal dialysis | $53,000 | Daily | Home |
| Home hemodialysis | $60,000 (+ equipment) | 5 to 7x per week | Home |
Source: GoodRx, American Association of Kidney Patients (AAKP), PMC research data.
How Medicare's ESRD Bundled Payment Works in 2026
Medicare is the primary payer for dialysis in the United States, and most ESRD patients qualify regardless of age. According to CMS.gov, the 2026 ESRD Prospective Payment System (PPS) base rate is $281.71 per dialysis session, up from $273.82 in 2025. CMS expects to pay approximately $6 billion to around 7,600 ESRD facilities in 2026.
What the bundle includes:
The single per-session payment covers everything the dialysis facility provides:
- All dialysis drugs and biologicals (including erythropoiesis-stimulating agents, iron supplements, and, as of January 1, 2025, phosphate binders)
- Laboratory services ordered and performed during the dialysis session
- Dialysis equipment, supplies, and capital costs
- Most oral-only drugs with an ESRD-specific use (added to the bundle starting January 1, 2025)
What is NOT in the bundle:
Some services are billed separately from the ESRD bundle. These include physician services (your nephrologist's monthly management fee), hospital inpatient dialysis, certain drugs not yet incorporated into the bundle, and items provided by a source other than the dialysis facility.
Why bundling matters to patients:
Before 2011, dialysis facilities billed each drug and lab test separately, which created financial incentives to prescribe more. The bundled payment limits that. However, it also means the facility earns a fixed amount per session regardless of how sick you are, unless CMS determines you qualify for an "outlier" add-on payment due to unusually high-cost care.
How CMS Adjusts the Base Rate
The $281.71 base rate is adjusted up or down based on several factors:
| Adjustment Factor | Effect on Payment |
|---|
| Wage index (local labor costs) | Varies by facility location |
| Training add-on (home dialysis) | Small addition for training patients |
| High-cost outlier add-on | Additional payment if costs far exceed base |
| Low-volume facility add-on | Support for rural/small facilities |
| Transitional Drug Add-On Payment (TDAPA) | Temporary add-on for new drugs |
| Quality Incentive Program (QIP) score | Can reduce payment up to 2% for poor quality |
What Patients Actually Pay: Out-of-Pocket Costs Under Medicare
Medicare Part B covers outpatient dialysis. After you meet the 2026 Part B deductible ($283), Medicare pays 80% of the approved amount. You pay the remaining 20% coinsurance per session.
If Medicare's approved amount per session is roughly $281.71, your 20% coinsurance is about $56 per session. At three sessions per week, that is roughly $168 per week, or about $8,700 per year in coinsurance alone, before counting any non-bundled charges.
There is no cap on Original Medicare out-of-pocket costs. For dialysis patients, this gap in coverage is significant.
Ways to Reduce Dialysis Out-of-Pocket Costs
| Coverage Option | What It Pays | Who Qualifies |
|---|
| Medicare Part B | 80% after deductible | ESRD patients (any age) |
| Medicaid (dual eligible) | Coinsurance, deductible, premiums | Low-income ESRD patients |
| Medicare Advantage | Varies, often caps OOP costs | Medicare-eligible patients |
| Medigap (supplement) | Part of or all coinsurance | Medicare patients buying supplement |
| American Kidney Fund grants | Up to $100/month for premiums/costs | Low-income patients |
| Hospital charity care | Varies by facility | Uninsured/underinsured patients |
According to Medicaid.gov, Medicaid is the second most common payer for dialysis after Medicare and can cover the 20% coinsurance that Medicare leaves behind. Many ESRD patients are dual-eligible (covered by both Medicare and Medicaid), which can bring out-of-pocket costs close to zero.
CPT Code 90999: What It Is and When It Appears on Your Bill
CPT code 90999 is the unlisted dialysis procedure code. Its full description is "Unlisted dialysis procedure, inpatient or outpatient." It is used when the dialysis service performed does not fit any of the standard dialysis CPT codes (90935 through 90940 for hemodialysis, 90945 and 90947 for peritoneal dialysis, and the ESRD monthly management codes 90951 through 90970).
When should 90999 appear on a dialysis bill?
Legitimate uses include:
- Experimental or investigational dialysis modalities with no assigned code
- Certain hemofiltration or hemodiafiltration services in specific settings
- Isolated situations where a hybrid procedure doesn't match any existing code
The billing problem with 90999:
Unlike standard dialysis CPT codes, 90999 carries no assigned relative value unit (RVU). There is no Medicare fee schedule rate for it. Payment is determined on a case-by-case basis, and documentation proving medical necessity must accompany every claim. Medicare typically pays 50 to 70% of a comparable dialysis code if the documentation is sufficient.
If you see CPT 90999 on a bill or explanation of benefits (EOB) and you were receiving routine hemodialysis, that is a red flag. Routine in-center hemodialysis sessions should be billed under 90935 or 90937. Using 90999 for routine dialysis is a billing error. Sometimes accidental, sometimes not.
Common Dialysis CPT Codes Compared
| CPT Code | Service Description | Has Set Rate? |
|---|
| 90935 | Single evaluation hemodialysis | Yes |
| 90937 | Hemodialysis requiring multiple evaluations | Yes |
| 90945 | Peritoneal dialysis, single evaluation | Yes |
| 90947 | Peritoneal dialysis, multiple evaluations | Yes |
| 90951-90970 | ESRD monthly management (by age/setting) | Yes |
| 90999 | Unlisted dialysis procedure | No (case-by-case) |
Source: CMS.gov ESRD billing resources.
How to Apply for Medicare ESRD Coverage
Medicare covers ESRD through Part A (hospital services) and Part B (outpatient dialysis). Unlike regular Medicare, ESRD Medicare eligibility starts at any age, not just 65.
2026 ESRD Medicare enrollment:
- Confirm your diagnosis. A physician must certify a diagnosis of end-stage renal disease requiring regular dialysis or a kidney transplant.
- Apply for Medicare. Call 1-800-MEDICARE (1-800-633-4227) or visit medicare.gov to start an ESRD Medicare application. You can also apply at any Social Security Administration office.
- Know your waiting period. For people under 65 who are not receiving SSDI, Medicare ESRD coverage typically starts the 4th month after you begin regular dialysis. If you start home dialysis, coverage may begin immediately.
- Enroll in a Medigap or Medicare Advantage plan. During your Initial Enrollment Period, you can enroll in a Medigap plan without underwriting (guaranteed issue rights). After this window, insurers may deny or charge more for Medigap.
- Apply for Medicaid if your income is low. Medicaid can fill the 20% coinsurance gap. Check eligibility at medicaid.gov.
Documents needed for ESRD Medicare application:
- Social Security number
- Proof of citizenship or immigration status
- Your physician's confirmation of ESRD diagnosis and dialysis start date
- Information on any current health insurance coverage
- Employment information (yours and your spouse's, if applicable)
Common reasons ESRD Medicare applications are delayed or denied:
- Dialysis start date not clearly documented by the treating facility
- Missing physician certification of ESRD
- Conflicting information about current insurance coverage
- Applicant not yet meeting the 3-month dialysis requirement (for delayed start coverage)
- Application submitted to wrong Social Security district office
Finding Billing Errors on Your Dialysis Statement
Dialysis bills are among the most complex in healthcare. A single month of in-center hemodialysis may generate charges for 12 to 14 sessions, labs drawn at each session, injectable medications, and a monthly physician management fee, all from different billers.
Common errors that inflate dialysis bills:
- Charging separately for drugs and labs that should be inside the ESRD bundle (and thus already covered by the $281.71 per session payment)
- Using CPT 90999 for routine sessions that should be coded 90935 or 90937
- Billing duplicate sessions
- Applying the wrong wage index, resulting in overstated facility charges
- Charging for services not rendered or for equipment the patient does not use
If your Medicare Summary Notice (MSN) or EOB shows charges that look unfamiliar, or if your dialysis facility is billing you for drugs that Medicare should already be covering through the bundle, you may be facing a billing error.
The CoveredUSA Bill Analyzer can scan your dialysis EOB or hospital bill line-by-line, compare each charge to the Medicare rate, and flag items that appear overbilled, miscoded, or duplicated. Upload your statement and get a report in about 30 seconds.
How to Get Help Paying for Dialysis
If you cannot afford dialysis costs after insurance, several programs can help:
American Kidney Fund (AKF): Provides grants to help pay health insurance premiums and out-of-pocket costs for dialysis patients. Visit kidneyfund.org for eligibility criteria.
National Kidney Foundation: Connects patients with state-level assistance programs and financial counselors. Visit kidney.org.
Dialysis facility social workers: Every dialysis center is required to have a social worker on staff. Ask to speak with them. They know every financial assistance program available in your state.
State pharmaceutical assistance programs: Some states provide additional drug coverage for ESRD patients on Medicare. Eligibility varies.
Upload your hospital bill to the free CoveredUSA Bill Analyzer to find errors, overcharges, and charity care options in 30 seconds.
Frequently Asked Questions
How much does dialysis cost per session in 2026?
Without insurance, in-center hemodialysis costs $500 to $1,000 per session in 2026. With Medicare, the facility receives a bundled payment of $281.71 per session from CMS, and patients pay 20% coinsurance (roughly $50 to $60 per session) after the Part B deductible. Patients with Medicaid as secondary coverage may pay nothing out of pocket.
What does Medicare pay for dialysis in 2026?
Medicare pays the ESRD dialysis facility a bundled rate of $281.71 per treatment session as of January 1, 2026 (up from $273.82 in 2025). This single payment covers drugs, labs, supplies, and equipment provided by the facility during the session. The patient pays 20% coinsurance on the Medicare-approved amount.
What is CPT code 90999?
CPT 90999 is the unlisted dialysis procedure code used when the service performed does not match any existing specific dialysis code. It has no preset Medicare payment rate. Payment is determined based on submitted documentation. If you see this code on a routine hemodialysis bill, it may be a coding error, since routine in-center hemodialysis should be billed under CPT 90935 or 90937.
Is all dialysis covered by Medicare?
Medicare Part B covers outpatient dialysis (in-center and at home) for patients with ESRD, at any age. Medicare Part A covers inpatient dialysis in a hospital. Most dialysis drugs, labs, and supplies are bundled into the per-session payment as of 2025-2026, so patients should not see separate charges for those items in most cases.
Can I get dialysis if I have no insurance?
Yes, but it is expensive without coverage. Dialysis facilities are required to provide treatment as an emergency procedure regardless of ability to pay. However, ongoing maintenance dialysis as an uninsured patient can lead to catastrophic debt. Most uninsured ESRD patients qualify for Medicare (which begins coverage within months of starting dialysis), Medicaid (for low-income individuals), or both. Apply immediately upon diagnosis.
What is the difference between in-center and home dialysis costs?
In-center hemodialysis costs more, roughly $78,000 to $120,000 per year without insurance. Home peritoneal dialysis costs approximately $53,000 per year without insurance. Home hemodialysis runs about $60,000 per year but also requires a $26,000 to $47,000 equipment investment. Under Medicare, patients pay 20% coinsurance for any modality, but home dialysis patients may benefit from a small training add-on payment CMS provides to facilities.
What charges should NOT appear separately on my dialysis bill if I have Medicare?
If you have Medicare and receive outpatient dialysis, you should not see separate line-item charges for: dialysis drugs (EPO, iron, heparin, phosphate binders), routine dialysis lab tests, dialysis supplies, or dialysis equipment. These are all bundled into the $281.71 per-session payment. If your bill shows these as separate charges, ask the facility's billing department or your Medicare plan to investigate.
How do I dispute a dialysis billing error?
Start by requesting an itemized bill from the dialysis facility. Compare it against your Medicare Summary Notice (MSN) or EOB. If charges appear that should be inside the bundle, or if CPT codes look wrong (like 90999 on a routine session), contact the facility's billing department in writing. If unresolved, file a complaint with your Medicare plan, your state's insurance commissioner, or the HHS Office of Inspector General at oig.hhs.gov.
