---
kind: "section"
citation: "42 C.F.R. § 413.172"
title: "42"
number: "413.172"
heading: "Principles of prospective payment."
url: "https://uscodex.org/cfr/42/413.172"
---

# §413.172. Principles of prospective payment.

- (a) Payment for renal dialysis services as defined in [§ 413.171](/cfr/42/413.171.md) and home dialysis services as defined in [§ 413.217](/cfr/42/413.217.md) of this chapter are based on payment rates set prospectively by CMS.
- (b) All approved ESRD facilities must accept the prospective payment rates established by CMS as payment in full for covered renal dialysis services as defined in [§ 413.171](/cfr/42/413.171.md) or home dialysis services. Approved ESRD facility means—
  - (1) Any independent ESRD facility or hospital-based provider of services (as defined in [§ 413.174(b)](/cfr/42/413.174.md?p=b) and [§ 413.174(c)](/cfr/42/413.174.md?p=c) of this part) that has been approved by CMS to participate in Medicare as an ESRD supplier; or
  - (2) **Any approved independent facility with a written agreement with the Secretary.** Under the agreement, the independent ESRD facility agrees—
    - (i) To maintain compliance with the conditions for coverage set forth in [part 494](/cfr/42/part494.md) of this chapter and to report promptly to CMS any failure to do so; and
    - (ii) Not to charge the beneficiary or any other person for items and services for which the beneficiary is entitled to have payment made under the provisions of this part.
- (c) CMS publishes the methodology used to establish payment rates and the changes specified in [§ 413.196(b)](/cfr/42/413.196.md?p=b) in the Federal Register.

## Notes

### Amendments

[62 FR 43668, Aug. 15, 1997, as amended at 73 FR 20474, Apr. 15, 2008; 75 FR 49198, Aug. 12, 2010]

### Source

Source: 62 FR 43668, Aug. 15, 1997, as amended at 86 FR 73515, Dec. 27, 2021, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 1395m, 1395x(v), 1395x(kkk), 1395hh, 1395rr, 1395tt, and 1395ww.

### Source

Source: 51 FR 34793, Sept. 30, 1986, unless otherwise noted.

### Amendments

[62 FR 43668, Aug. 15, 1997, as amended at 73 FR 20474, Apr. 15, 2008; 75 FR 49198, Aug. 12, 2010]