July 2, 2026: CMS ISSUES PROPOSED 2027 ASC PAYMENT RULE: DECREASES FOR MANY EYE PROCEDURES
On July 2, the Centers for Medicare and Medicaid Services (CMS) issued its proposed CY 2027 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC). The proposed regulation will soon be published in the Federal Register; OOSS and interested parties will have an opportunity to submit public comments for the next 60 days.
ASC Annual Payment Rate Updates
For the period 2019-2026 CMS has updated 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. CMS is again providing ASCs with the Hospital Market Basket in 2027.
Proposed 2027 ASC Payment Rates
Under the ASC payment system, facilities receive a percentage of the relative weight assigned to a code for procedures furnished in HOPDs. The relative weights are re-calibrated each year based on a complex formula that takes into account a number of factors, including changes in hospitals’ costs in providing such services and the mandate that the ASC payment system remain budget-neutral.
Under the proposed rule, ASC payment rates would be updated, on average, by 2.4 percent in 2027 (reflecting the hospital market basket index of 3.2 percent less the MFP adjustment of 0.8 percent). 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 reduced reimbursement cataract and a number of other ophthalmic services, In the chart below, we have listed the rates for high-volume ophthalmic surgical services performed in ASCs.
This is very disappointing news. You will recall that last year CMS proposed a significant cut in cataract facility fees and the ophthalmology community successfully lobbied for a sizable increase. The agency states that rate reductions for some specialties are due to the application of budget neutrality adjustments. Working with other ophthalmology and ASC organizations, we 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.
The following is a representative sampling of the proposed rates:
Proposed 2027 ASC Payment Rule for Ophthalmic Services
| CPT | Description | 2026 Final | 2027 Proposed |
| 66984 | Cataract | $1,255.73 | $1,211.57 |
| 66821 | Yag | 301.90 | 291.78 |
| 66170 | Trabeculectomy | 1,255.73 | 1,211.57 |
| 67036 | Vitrectomy | 2,203.87 | 2,135.94 |
| 15823 | Blepharoplasty | 1,128.57 | 1,075.80 |
| 65820 | Goniotomy | 2,203.87 | 2,135.94 |
| 66991 | Cataract w/Stent | 4,014.69 | 4,380.02 |
| 66988 | Cataract with ECP | 2,203.87 | 2,135.94 |
| 65710 | Cornea Transplant | 2,786.88 | 2,702.57 |
ASC Quality Reporting
The All-Cause Hospital Transfer/Admission measure (ASC-4) is a current mandatory reporting metric for Ambulatory Surgery Centers under the CMS ASC Quality Reporting Program. Facilities must track and report every instance where a patient is directly transferred or admitted to a hospital setting upon discharge from the ASC, regardless of the reason. The current measure reports an overall rate of transfers/admissions and does not specify when during the ASC encounter the need for transfer/admission is identified. CMS is soliciting comments regarding whether this measure should be reported by stratification, e.g., preop, intraop, or postop transfer. We are pleased to report 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.
For the past several years, OOSS and the ASC and ophthalmology communities have been engaged in the process of developing and proposing new and appropriate ophthalmic ASC measures. The agency adopted in 2019 a new ophthalmic quality measure, ASC 14: Unplanned Anterior Vitrectomy, which assesses the percentage of cataract surgery patients who have the procedure in an ASC. We will continue to recommend implementation of an ASC quality measure for TASS.
Non-Opioid Drugs and Devices
For the past several years, CMS has separately reimbursed facilities that utilize non-opioid treatments that have FDA-approved indications for relief of pain. To date, Omidria and Dextenza have been the only ophthalmic products that have achieved such reimbursement status OOSS will continue to recommend that the agency also separately pay for drugs and devices that have indications for relieving inflammation since this condition is often a precursor to pain.
Payment for New Technology IOLs
ASCs that implant lenses that have secured NTIOL status receive an additional $50 in facility reimbursement. CMS reports that there were no applications submitted by ophthalmics manufacturers requesting NTIOL status for lenses for the 2026 ASC payment rate rulemaking. As an incentive for innovation in monofocal IOL technology, OOSS and the IOL manufacturers are recommending that the $50 payment for NTIOL be increased to about $100 to account for inflation.
Should you have any questions, please contact OOSS Washington Counsel Michael Romansky at mromansky@OOSS.org.
The proposed regulation can be reviewed at: https://public-inspection.federalregister.gov/2026-13656.pdf