Articles related to CODING & REIMBURSEMENT

HRSA’s revised 340B rebate pilot could require covered entities to purchase selected high-cost drugs at full price and recover discounts through manufacturer rebates beginning in 2027, prompting hospitals to evaluate data infrastructure, vendor readiness, and reimbursement workflows while legal and congressional challenges continue.

Radiation oncology practices report substantial revenue declines following 2026 CMS coding changes, with some centers citing reimbursement reductions of 15% to 30%. Stakeholders warn the financial pressures could affect treatment access, particularly in community and rural settings.

CMS has proposed 2027 ambulatory surgery center payment changes that would reduce reimbursement for several high-volume ophthalmic procedures, including cataract surgery. The proposal remains under review as ophthalmology organizations evaluate potential impacts on practice operations and patient access.

CMS proposed 2027 Physician Fee Schedule changes that would reduce reimbursement for certain same-day evaluation and management services performed with procedures. Ophthalmology organizations warned the changes could affect glaucoma treatment workflows, although the proposal remains under review.

Retina practices are adjusting after Good Days funding limitations reduced copay support for some patients requiring chronic anti-VEGF therapy. Medicare Advantage patients appear especially exposed to affordability pressure.

Retina, glaucoma, and cornea specialists share subspecialty-specific coding pearls covering modifier use, bundled surgical codes, E/M versus eye exam code selection, and documentation requirements for imaging reimbursement.