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 2020 MPFS and Quality Payment Program proposed rules. CMS will release its Final Rule on or around November 1, 2019. Click below for previous updates on our efforts and analysis:

ASRS Comments on Proposed CY2020 MPFS and QPP Rules Oct 2, 2019

ASRS is Fighting for Fair Medicare Pay for Office Visits August 13, 2019

CMS Releases 2020 Physician Fee Schedule and Quality Payment Program Proposed Rule July 29, 2019

Related articles:

ASRS Analysis of Previous Rules

2019 MPFS Final Rule Analysis

2018 MPFS Final Rule Analysis

2017 MPFS Final Rule Analysis

Comment Letters

Advocacy Timeline

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