The Centers for Medicare and Medicaid Services (CMS) proposed CY 2026 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC) contains good news, including a 2.4% average increase in payment rates. According to a press release from the Outpatient Ophthalmic Surgery Society (OOSS), the proposed rule, released yesterday, incorporates multiple policies for which the society has long advocated.

Hospital Market Basket Rates Extended, Reimbursements Rise

Changes include CMS extending its policy of the 2019-2025 period, in which CMS updated ASC payment rates by the Hospital Market Basket rather than the lower Consumer Price Index-Urban, to 2026 while it further studies the issue. The resulting 2.4% payment increase represents an average across all ASC procedures, OOSS notes; as such, specific procedures will be allocated rates that are higher or lower “and they are linked directly to what hospitals are paid under a complex formula.”

A table provided by OOSS, below, lists the rates for high-volume ophthalmic surgical services performed in ASCs.

Table. Proposed 2026 ASC Payment Rule for Ophthalmic Services

On the other hand, for 2026, CMS has proposed drops in payments for 66984 and 66170. OOSS says it will “lobby aggressively to move these services into positive territory.”

Changes to NTIOL Reimbursement, Quality Reporting

ASCs that implant lenses that have secured new technology IOL (NTIOL) status receive an additional $50 in facility reimbursement, OOSS reports.

Additionally, CMS is removing the following measures from ASC Quality Reporting:

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

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. 

The proposed regulation will soon be published in the Federal Register; public comments can be submitted until September 15th. OOSS says it has established a schedule for member input that will enable the society to address all relevant concerns in a timely and effective manner. For more information on the proposed rule and OOSS’s comment schedule, go to:

https://ooss.org/2025/07/16/cms-issues-proposed-2026-asc-payment-rule-update-of-2-4-percent/

To read the proposed rule, go to:

https://public-inspection.federalregister.gov/2025-13360.pdf