Medicare Reimbursement and Coverage

The ASRS fights for:

  • Fair Medicare reimbursement and coverage for retina procedures, services and drugs through our comment letters and RUC and CPT Editorial Panel representation 
  • CMS to formally recognize in its programs the unique qualifications of retina specialists to treat retina diseases

Medicare Physician Fee Schedule

The Medicare Physician Fee Schedule (MPFS), which dictates physician payment, is established annually by CMS and takes into account recommendations from groups such as the American Medical Association (AMA) Specialty Society Relative Value Scale (RVS) Update Committee (RUC), its own analysis, as well as legislative mandates. Reimbursement for codes is based on the resources needed to perform the associated services.  

The ASRS, Retina and Macula Societies provided comprehensive retina-related feedback on both the proposed CY 2019 MPFS and Quality Payment Program rules. On November 1, 2018 the final rules were released by CMS. Click to read a top-level analysis by ASRS.

ASRS Analysis of Previous Rules

2018 MPFS Final Rule Analysis

2017 MPFS Final Rule Analysis

Comment Letters

Advocacy Timeline

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