Medicare payment rates for cataract surgery and several other high-volume ophthalmic procedures performed in ambulatory surgery centers (ASCs) will decrease in 2027 under a final rule issued November 4 by the Centers for Medicare & Medicaid Services (CMS), according to the Outpatient Ophthalmic Surgery Society (OOSS). The rule takes effect January 1, 2027, and affects approximately 6,400 ASCs nationwide.

According to OOSS, reimbursement for cataract surgery will decline for the first time in 28 years. The ASC payment rate for cataract surgery (CPT code 66984) will decrease from $1,255.73 in 2026 to $1,220.03 in 2027. These rates apply to ASC facilities and are separate from surgeons' professional fees.

“While we are pleased that the final 2027 proposed ASC payment rule includes a 1% higher cataract rate than what was proposed, we are disappointed in the final rule. This represents the first time in 28 years that our facilities have not received a positive update,” said Michael A. Romansky, JD, OOSS’s Washington, DC, counsel.

From 2019 through 2026, CMS updated ASC payment rates using the hospital market basket rather than the lower Consumer Price Index for All Urban Consumers. Under this policy, ASCs received the same annual update as hospitals, subject to certain adjustments. CMS will continue using the hospital market basket in 2027. OOSS said it will advocate for making this methodology permanently applicable to ASC payment updates.

Final 2027 ASC Payment Rates

Under the ASC payment system, CMS calculates facility payment rates using relative weights derived from the hospital outpatient payment system, subject to ASC-specific adjustments.

CMS recalibrates ASC payment weights annually, subject to budget-neutrality requirements.

According to CMS, the agency finalized a 2.3% payment update for ASCs meeting applicable quality reporting requirements in 2027, reflecting a 3.2% hospital market basket increase reduced by a 0.9-percentage-point productivity adjustment. The final update is lower than the 2.4% increase initially proposed. However, payment changes vary by procedure, with several high-volume ophthalmic services receiving lower reimbursement, according to OOSS.

Impact on Ophthalmic Procedures

According to OOSS, changes to CMS's budget-neutral payment methodology shift reimbursement toward procedures more recently added to the ASC-covered procedures list, including cardiovascular and orthopedic services with significant device costs. These changes will reduce reimbursement for many high-volume ophthalmic procedures.

“Why did this occur? Essentially, in order to meet budget neutrality requirements, CMS recalibrated virtually all of the current highest volume procedures downward in order to accommodate costly high device-intensive procedures, like cardiovascular and orthopedic, that have been added to the ASC procedures list in recent years,” explained Romansky. “OOSS and the ASC and ophthalmology communities, as well as industry, will press next year for formula adjustments that get cataract and other vital eye services back into positive update territory.”

Although most final 2027 payment rates for the ophthalmic procedures listed below are higher than initially proposed, most remain below 2026 levels.

An exception is cataract surgery with stent placement (CPT code 66991), for which the ASC payment rate will increase by approximately 8.5%, from $4,014.69 in 2026 to $4,356.03 in 2027, according to OOSS.

2027 ASC Payment Rates for Ophthalmic Services

ASC Quality Reporting

In the final rule, CMS removed one measure from the ASC Quality Reporting Program but did not finalize any new measures. According to OOSS, CMS did not move forward with requiring facilities to report improvements in patient visual function within 90 days following surgery. Romansky noted that this is presently a voluntary measure and very unlikely it will ever be made mandatory.

The organization and other ophthalmology stakeholders have advocated for the development of ophthalmic-specific ASC quality measures.

OOSS noted that CMS adopted ASC-14, Unplanned Anterior Vitrectomy, in 2019. The organization said it will continue recommending implementation of an ASC quality measure for toxic anterior segment syndrome (TASS).

Nonopioid Drugs and Devices

CMS has separately reimbursed facilities for certain nonopioid treatments with FDA-approved indications for pain relief. According to OOSS, Omidria (phenylephrine and ketorolac; Rayner) and Dextenza (dexamethasone ophthalmic insert; Ocular Therapeutix) are the only ophthalmic products that have received this reimbursement status.

OOSS said it will continue advocating for separate reimbursement for drugs and devices indicated for treating inflammation, which the organization noted can precede pain.

The final regulation can be reviewed at: https://public-inspection.federalregister.gov/2026-22739.pdf