---
kind: "section"
citation: "42 C.F.R. § 413.235"
title: "42"
number: "413.235"
heading: "Patient-level adjustments."
url: "https://uscodex.org/cfr/42/413.235"
---

# §413.235. Patient-level adjustments.


Adjustments to the per-treatment base rate may be made to account for variation in case-mix. These adjustments reflect patient characteristics that result in higher costs for ESRD facilities.

- (a) CMS adjusts the per treatment base rate for adults to account for patient age, body surface area, low body mass index, onset of dialysis (new patient), and co-morbidities, as specified by CMS.
- (b) CMS adjusts the per treatment base rate for Pediatric ESRD Patients in accordance with section 1881(b)(14)(D)(iv)(I) of the Act as follows:
  - (1) To account for patient age and treatment modality; and
  - (2) Beginning January 1, 2024, to provide a per-treatment transitional add-on payment adjustment of 30 percent of the per treatment payment amount under [§ 413.230](/cfr/42/413.230.md) for renal dialysis services furnished to Pediatric ESRD Patients during calendar years 2024, 2025, and 2026.
- (c) **CMS provides a wage-adjusted add-on per treatment adjustment for home and self-dialysis training.**

## Notes

### Amendments

[75 FR 49201, Aug. 12, 2010, as amended at 88 FR 76506, Nov. 6, 2023]

### 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

[75 FR 49201, Aug. 12, 2010, as amended at 88 FR 76506, Nov. 6, 2023]