Ambulatory surgical centers (ASCs) enter 2026 facing a mixed Medicare environment. On the physician side, the 2026 Medicare Physician Fee Schedule (MPFS) introduces 2 major policies that reduce professional reimbursement for ASC-based surgery, even though the physician conversion factor rises modestly. On the facility side, the US Centers for Medicare and Medicaid Services (CMS) finalized a limited ASC payment increase and several ophthalmology-specific updates that improve or stabilize reimbursement for high-volume procedures.
Professional Payment Tightens in ASCs
The MPFS for 2026 reshaped physician payment in facility settings, including ASCs, through 2 significant changes:
1. Facility indirect practice expense (PE) cut: CMS finalized a new indirect PE methodology that reduces facility-based indirect PE to 50% of the non-facility rate. CMS argues that physicians performing procedures in ASCs incur fewer indirect overhead costs because many expenses (clinical staff, equipment, space, supplies) are absorbed by the facility. Under budget neutrality, the indirect PE dollars removed from facility services are redistributed primarily to non-facility (office-based) care rather than retained within surgical specialties. The result is a noticeable decrease in the physician portion of reimbursement for ASC-based procedures.
2. Work relative value unit (RVU) efficiency adjustment: CMS also applied a -2.5% adjustment to work RVUs and intraservice time for most non–time-based CPT codes. The agency contends that improvements in surgeon experience, technology, and workflow have shortened real-world procedure time. For ASC-heavy surgical specialties, this means lower work values for many core services. In ophthalmology, commonly performed ASC codes, such as cataract surgery and blepharoplasty, are among those affected.1
ASC Prior Authorization Demonstration
CMS launched a 5-year ASC prior authorization (PA) pilot for selected services that CMS believes are vulnerable to improper payment or cosmetic use. Targeted ophthalmic services include blepharoplasty and botulinum toxin injections. The program rolled out in 2 phases. Phase 1 includes California, Florida, Tennessee, Pennsylvania, Maryland, Georgia, and New York, with PA requests available on January 5, 2026, for dates of service on or after Jan. 19, 2026. Phase 2 includes Texas, Arizona, and Ohio, with PA requests available on Feb. 2, 2026, for dates of service on or after Feb.16, 2026.2 Although CMS labels participation “voluntary,” failure to submit PA may lead to prepayment review and delayed or denied claims. Denials can also trigger associated professional claim denials, creating additional financial risk.
2026 ASC Payment System Final Rule
For ASCs meeting quality reporting requirements, CMS finalized a 2.6% payment increase, setting the 2026 ASC conversion factor at $56.322. CMS also extended use of the hospital market basket update as the ASC update factor through the end of 2026, while continuing to study outpatient surgical migration into ASCs.3
Ophthalmic Procedure Increases
Most ophthalmic procedures in ASCs will see facility rate increases of about 1% to 10%. Notably, CPT 65780 (ocular surface reconstruction with multilayer amniotic membrane transplantation) is now classified as device-intensive, resulting in a 39% payment increase compared with 2025, and blepharoplasty procedures are expected to receive a 15% ASC facility payment increase.
Cataract and Retinal Surgery
CMS recalculated the ambulatory payment classification for cataract removal surgeries after advocacy from the ophthalmology community. The finalized 2026 ASC facility rate for CPT 66982 and 66984 is $1,255.73, a 3.4% increase over current payment. This correction is meaningful for ASCs given cataract surgery’s central role in ophthalmic volume and revenue. CMS declined to reprice ASC rates for retinal detachment repair codes CPT 67108 and 67113.
Minimally Invasive Glaucoma Surgery
CMS finalized assignment of CPT 66989, 66991, and 0671T to APC 5493 (Level 3 intraocular procedures) and designated these codes as device-intensive in ASCs, improving reimbursement alignment with costly implants. CMS also designated CPT 0621T (trabeculostomy ab interno by laser) as device-intensive but applied a 4.6% device offset instead of the default 31%, using limited 2024 claims data. The resulting 2026 ASC facility rate is $3,648.64, and we remain concerned that this offset understates true device costs.4
Drugs: Pass-Through Expirations and Non-opioid Payment Caps
Pass-through drugs receive temporary separate ASC payment to support access to new products, but that status ends unless other CMS payment criteria are met. Below is a summary of ophthalmic drugs that are impacted by the latest updates.4
• Expired Dec. 31, 2025:
- Byooviz ranibizumab-nuna biosimilar (Samsung Bioepis; Q5124)
• Expiring in 2026:
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Iheezo (Harrow); J2403 expired March 31, 2026
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Cimerli (Sandoz); Q5128 expires March 31, 2026
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Syfovre (Apellis Pharmaceuticals); J2781 expires June 30, 2026
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Eylea HD (Regeneron); J0177 expires Dec. 31, 2026
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Izervay (Astellas); J2782 expires Dec. 31, 2026
Once pass-through status expires, a drug may remain separately payable if it meets the requirements of the separately payable non-pass-through policy or non-opioid pain management drugs and biologicals policy. CMS confirmed continued separate payment eligibility under the ASC non-opioid treatment policy for:
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Omidria (Rayner Surgical);
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J1097 (Ocular Therapeutix)
J1096CMS will continue limiting payment to 18% of the volume-weighted average of the top 5 primary procedures billed with the drug. For 2026, caps are:
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Dextenza: $419.57 per date of service
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Omidria: $414.05 per date of service
Ambulatory Surgical Center Quality Reporting Program
CMS finalized several Ambulatory Surgical Center Quality Reporting Program policies that reduce near-term burden:
- ASC-11 (cataracts: improvement in visual function within 90 days) remains voluntary through 2031.
- The COVID-19 Vaccination Coverage Among Healthcare Personnel measure is removed beginning with the 2024 reporting period (2026 payment period).
- Three health-equity measures are removed beginning with the 2025 reporting period:
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- Facility commitment to health equity,
- Screening for social drivers of health, and
- Screen positive rate for social drivers of health
- Facility commitment to health equity,
Conclusion
The 2026 ASC payment system brings modest facility growth and real ophthalmology wins—especially the cataract APC correction, MIGS device-intensive designations, and broad ophthalmic increases. But professional reimbursement in ASCs tightens sharply under the MPFS, and the new PA pilot adds workflow and documentation requirements in 10 states. ASCs should prepare for reduced physician payment, reassess case profitability for high-cost devices and drugs, and build PA processes into scheduling and clinical documentation to protect timely payment and maintain patient access.
References
1. 2026 Medicare Fee Schedule - American Academy of Ophthalmology. Accessed November 14, 2025. https://www.aao.org/advocacy/medicare-fee-schedule/2026
2. Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services | CMS. Accessed on November 24, 2025. https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-pre-claim-review-initiatives/prior-authorization-demonstration-certain-ambulatory-surgical-center-services
3. Calendar Year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule (CMS-1834-FC) | CMS. Accessed on November 24, 2025. https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center
4. CMS Finalizes 2026 2.6% Pay Increase for Hospital Outpatient Departments, ASCs - American Academy of Ophthalmology. Accessed November 25, 2025. https://www.aao.org/advocacy/eye-on-advocacy-article/cms-finalizes-2026-pay-increase-hopd-asc