DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS ⚖️ Legal / Ethical Complexity
CMS’s proposed 2027 ASC payment rule would reduce reimbursement for several common ophthalmic procedures despite an overall ASC payment update. The proposal also intersects with evolving Medicare coverage policies for glaucoma therapies and ongoing billing compliance questions surrounding office-based surgery.
Professional Impact
- CMS proposed reducing cataract surgery ASC reimbursement from $1,255.73 to $1,211.57, approximately a 3.5% decrease.
- Several ophthalmic procedures, including YAG capsulotomy, trabeculectomy, vitrectomy, goniotomy, and corneal transplantation, would also receive lower payments.
- Proposed Medicare coverage policies could limit access to drug-eluting glaucoma delivery systems through step-therapy style requirements.
- Ongoing uncertainty remains regarding appropriate billing methodologies for office-based cataract surgery under Medicare Part B.
Action Items
- Review projected ASC reimbursement changes for high-volume ophthalmic procedures.
- Monitor CMS rulemaking and final payment determinations for 2027.
- Evaluate financial implications of proposed glaucoma coverage restrictions.
- Assess office-based surgery billing practices for consistency with current CMS guidance.
