November 21, 2025: CMS issues final 2026 ASC Payment Rule: Cataract rate increased by 3.3 percent above 2025 levels
On November 21, the Center for Medicare and Medicaid Services (CMS) issued its final CY 2026 payment rate regulation for hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs).
ASC Payment Rate Updates
Under the final rule, overall ASC payment rates will be updated by 2.6 percent, reflecting the hospital market basket index of 3.3 percent less the MFP adjustment of 0.7 percent). The update percentage of 2.6 represents an average across all ASC procedures.
As we have reported, CMS proposed that 2026 payments for cataract surgery (66984 and 66170) be reduced by 4.7 percent below 2025 levels. OOSS, joined by our colleague ophthalmology and ASC communities (and the many OOSS members who submitted comments), maintained that CMS made a significant calculation error in establishing the cataract rate and requested that the agency review its work and correct any errors. As a result of this effort, the 2026 facility fee for cataract surgery will be $1255 – an increase by 8.4 percent above the proposed rule and a 3.3 percent over 2025 levels.
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 over twenty 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. The policy was supposed to come up for review in this rulemaking. However, because of data problems associated with the pandemic, the agency last year extended the application of the Hospital Market Basket to ASCs for an additional two years, through 2025 and, in this year’s final rule, the trial has been extended through 2026. OOSS will continue to strenuously recommend that CMS maintain permanently the application of the Hospital Market Basket in computing the annual ASC payment update.
The following is a representative sampling of the proposed rates:
Final 2026 ASC Payment Rule for Ophthalmic Services
| CPT | Description | 2025 Rate | 2026 Proposed | 2026 Final | % change vs 2025 |
| 66984 | Cataract | $1,214 | $1,157 | $1,255.73 | +3.4% |
| 66821 | Yag | $295 | $297 | $301.90 | +2.3% |
| 66170 | Trabeculectomy | $1,214 | $1,157 | $1,255.73 | +3.4% |
| 67036 | Vitrectomy | $2,094 | $2,231 | $2,203.87 | +5.2% |
| 15823 | Blepharoplasty | $982 | $1,136 | $1,128.57 | +14.9% |
| 65820 | Goniotomy | $2,094 | $2,231 | $2,203.87 | +5.2% |
| 66991 | Cataract w/Stent | $3,760 | $3,978 | $4,014.69 | +6.8% |
| 66988 | Cataract with ECP | $2,094 | $2,936 | $2,203.87 | +5.2% |
| 65710 | Cornea Transplant | $2,628 | $2,759 | $2,786.88 | +6% |
Coverage of Drugs Used During Cataract Surgery
OOSS has long advocated that CMS develop a comprehensive policy that covers drugs that are administered at the time of ophthalmic surgery, that are direct substitutes for postoperative medications, or that have an FDA-approved indication to treat/prevent post-operative issues, such as pain, inflammation, or infection, separately under Medicare Part B. To date, Omidria and Dextenza are the products that are covered separately in the agency’s non-opioid pain management program.
ASC Quality Reporting
We are pleased that CMS is removing several measures that were opposed by OOSS and the ophthalmology and ASC communities: (1) the COVID-19 Coverage Among HCP measure; (2) the Facility Commitment to Health Equity (FCHE) measure beginning with the CY 2025 reporting period/CY 2027 program determination; (3) the Screening for Social Drivers of Health (SDOH) measure beginning with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination, and (4), the Screen Positive Rate for Social Drivers of Health (SDOH) measure beginning with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination.
We are also pleased that, as recommended by OOSS, no further action has been taken by the agency to require facilities to report on improvements in patient visual function in the 90 days following surgery.
We will keep you abreast of further developments. Should you have any questions, please contact OOSS Washington Counsel Michael Romansky at mromansky@OOSS.org.
The final regulation can be reviewed at: https://www.federalregister.gov/public-inspection/2025-20907/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment