March 31, 2026: Medicare Part B Reimbursement for Office Cataract Surgery

Many OOSS members have requested guidance regarding appropriate billing practices for office-based cataract surgery (OBS) under Medicare Part B.  In response, OOSS has 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.   

Based on current policies, OOSS can confirm the following:

• For Medicare Part B, surgeons can report the CPT code for cataract surgery and the HCPCS code for the IOL. 
• Offices cannot balance bill the Medicare Part B patient for facility or administrative fees because only the cataract professional fee is defined. 
• Claims for surgical services performed in the office must report the correct place of service (POS) of 11 and not report as an ASC (24) or HOPD (22).
• The physician performing cataract surgery in the office cannot bill separately for anesthesia because these services, except under limited circumstances, are encompassed within the professional fee when provided by the surgeon. 
• Reported CPT and HCPCS codes need to accurately represent the services performed and documented in the patient’s medical record. Neurology codes being submitted in some instances relate to nerve, arm or leg services; there is no indication or confirmation from CMS or Medicare contractors that these services may be billed by ophthalmologists when performing cataract surgery to provide reimbursement to cover cataract surgical facility fees.

Ophthalmologists and administrators should 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 await clarification from CMS regarding OBS payment practices and will keep you abreast of further developments. Additional analysis is provided by the Academy here. In the meantime, should you have any questions, please reach out to OOSS General Counsel Michael Romansky, JD at mromansky@OOSS.org.