The Outpatient Ophthalmic Surgery Society (OOSS) was founded 45 years ago, its primary objective being to represent at the nation's capital the interests of ophthalmic ambulatory surgery centers (ASC), the surgeons who operate therein, and the patients we serve. Our advocacy efforts have focused on achieving fair ASC facility payments and ensuring that our facilities are subject to reasonable (and not overly burdensome) patient regulations.

Kudos to you who, over decades, have provided innovative care to the nation’s elderly and have made surgery in the ASC the standard of care for the treatment of cataract and other eye conditions. Patient health and safety are unparalleled in the ASC. How effective have we been in improving care while at the same time reducing government health expenditures? The numbers are staggering. This past May, KNG Consulting, LLC issued a report, “Medicare Savings From Use of Ambulatory Surgery Centers,” a follow-up to a similar 2019 report.¹ The study demonstrates that ASCs have been a driving force in saving billions of Medicare dollars and that this trend will continue over the next decade. From 2019 to 2024, the Medicare savings generated by procedures performed in ASCs instead of hospitals totaled $27.9 billion; cataract and related services accounted for $12.26 billion, or 37%. From 2025-2034, cataract services performed in ASCs are expected to generate savings to Medicare of approximately $35 billion.

ASC Payment Rates in 2026 and 2027

Cataract facility fees have increased annually for the past 26 years. In 2025, the Centers for Medicare and Medicaid Services (CMS) issued its proposed FY 2026 ASC payment regulation. At that time, the agency proposed a 4.7% reduction in ASC facility fees for cataract surgery. After a herculean lobbying effort by OOSS and the ophthalmology and ASC communities, CMS reversed course and instead secured a 7.5% increase in facility reimbursement. OOSS has achieved many successes since its inception, but each year poses new challenges, as well as opportunities, and we must remain vigilant and zealous in our lobbying efforts over the next several months.

We may face an even greater challenge in 2027, possibly a decrease in cataract and other ophthalmic procedures. Under the proposed rule, ASC payment rates would be updated, on average, by 2.4% in 2027, reflecting the hospital market basket index of 3.2% less the MFP adjustment of 0.8%. The update percentage of 2.4% represents an average across all ASC procedures; as such, specific procedures will be allocated rates that are higher or lower, and they are linked directly to what hospitals are paid under the complex formula discussed above. Unfortunately, CMS has proposed reducing reimbursement by 3.3% for cataract as well as other ophthalmic services. Table 1 shows the rates for high-volume ophthalmic surgical services performed in ASCs.

Table 1: Proposed 2027 ASC Payment Rule for Ophthalmic Services

This is very disappointing news for ASCs. The agency states that rate reductions for some specialties are due to the application of arbitrary budget neutrality adjustments. Working with other ophthalmology and ASC organizations, OOSS will be analyzing the rates to determine if CMS, like last year, erred in its calculations. OOSS will certainly seek to secure a positive update in 2027. We will be calling on you to assist in this initiative by sending comments to CMS later this summer. 

ASC Annual Payment Updates 

Five years ago, CMS agreed, for the period 2019-2023, to update ASC payment rates by the Hospital Market Basket rather than the lower Consumer Price Index-Urban. OOSS has been a leader in the effort to effectuate this change for more than 20 years, seeking to persuade both CMS and Congress of its merits. Under this policy, ASCs have received the same update as hospitals, subject to certain adjustments. OOSS will continue to strenuously recommend that CMS permanently maintain the application of the Hospital Market Basket in computing the annual ASC payment update.

Limits to Payments for Drug-Eluting Systems

Medicare contractors have issued a proposed Local Coverage Determination (LCD) that embodies the potential to significantly limit ophthalmologists’ ability to implant anterior segment intraocular nonbiodegradable drug-eluting systems. To secure reimbursement for these services, patients will have to have had a history of failed management, defined by these parameters:

• The patient has tried at least 2 ophthalmic topical drops (given as sequential monotherapies or together simultaneously) for the treatment of open-angle glaucoma or ocular hypertension.

• The ophthalmic drops did not achieve the initial treatment goal of a reduction of 20% to 30% from the patient’s baseline intraocular pressure (IOP) measurement.

• Adverse side effects from different ophthalmic drops were severe enough to warrant discontinuation.

• The patient is unable to physically place eye drops due to disability such as severe tremors or loss of use of the dominant hand, and there is no caretaker who is able to perform the administration of the drops.

•  The patient has a history of failed selective laser trabeculoplasty (SLT), defined as the procedure did not result in clinically significant reduction of IOP.

Medicare contractors held several hearings in June to hear from interested parties, including ophthalmology organizations. At these meetings and in our formal comments filed with the contractors, OOSS—along with the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the American Glaucoma Society—addressed a number of concerns and made the following recommendations:

• The LCD should be rescinded until additional clinical data are available, and claims should be adjudicated on a case-by-case basis.

• The contractors should consider modifying step therapy requirements to require 1 drop instead of 2 and cover concomitant cataract with other eye procedures.

• The LCD should be modified to require that therapy include a failed history of medical management with drops or (not and) a history of failed SLT.

• The LCD should permit readministration after 1 year (not 2) to be consistent with FDA-approved labeling.

Office-Based Cataract Surgery Billing Concerns

Many OOSS members have requested guidance regarding appropriate billing practices for office-based cataract surgery (OBS) under Medicare Part B. In response, OOSS and the Academy have sought clarification from CMS with respect to several such practices, most notably, the use of specific “code sets” to enable enhanced payment for cataract surgery performed in the office. These code sets include, for example, reimbursement claims for certain neurological services, eg, neuroplasty and neurolysis.

We recommend that our members review the Academy’s recent detailed guidance on OBS payment policy: The guidance states that, “we have no confirmation from CMS or any insurance carrier indicating approval for additional reimbursement for OBS beyond the standard professional fees for performing cataract surgery.”² We have reached out to CMS and Medicare Administrative Contractors (MACs) regarding the appropriate way to bill OBS and are awaiting a response. Therefore, we cannot currently confirm that this code-set methodology is acceptable for any payer including Medicare per published policies. OOSS will update this guidance as we learn more.

Other key requirements:

• For Medicare Part B, surgeons operating in the office can only report the CPT code for cataract surgery and the HCPCS code for the intraocular lens. 

• Offices cannot balance bill the Medicare Part B patient for facility, operating room, administrative, or concierge fees, because these costs are part of the cataract professional fee. 

• CPT and HCPCS codes should represent the services performed and documented in the patient’s medical record. CPT codes for neuroplasty and neurolysis should not be reported by the surgeon along with cataract surgery because these codes relate to major nerve, arm or leg services and are not performed with ophthalmic procedures. 

It is important that ophthalmologists and administrators consult with an experienced health care attorney to ensure that such arrangements and contracts are in compliance with CMS reimbursement policies and other relevant federal and state laws. We are awaiting further clarification from CMS regarding OBS payment practices and will provide updates on further developments.

Despite our successes on the legislative and regulatory fronts, we face innumerable challenges at this very moment. I urge you to continue to support OOSS and to be active in our grassroots lobbying initiatives. In deciding whether to so engage, please ask yourself these questions: In the absence of OOSS’s work over these past 4 decades, could surgeons still own and refer their patients to ASCs? Would our facility payments have increased by 350%, or would they have declined like professional fees? Would we have been able to perform and be reimbursed for virtually every ophthalmic procedure in the ASC? Would Medicare ASC facility regulations be more burdensome, threatening the very viability of the OASC?

References

1. Ambulatory Surgery Center Association. Medicare savings from use of ambulatory surgery centers. May 6, 2026. Accessed July 24, 2026. https://www.ascassociation.org/asca/about-ascs/savings/medicare-savings-from-use-of-ambulatory-surgery-centers

2. American Academy of Ophthalmology. Office-based surgery. Published January 22, 2026.  Accessed July 23, 2026. https://www.aao.org/practice-management/news-detail/office-based-surgery

Michael A. Romansky, JD, is corporate counsel for OOSS. He can be reached at mromansky@OOSS.org.