Advocacy & Practice Updates — Advocacy & Practice
CMS Intends to Monitor Payment Adequacy for Retina Procedures
Responding to concerns raised by ASRS about growing surgical access issues, CMS noted in the recently released 2026 Hospital Outpatient (HOPD) and ASC final rule that it would monitor the payment adequacy of retinal and intraocular procedures. In joint comments on the proposed rule submitted with the Ophthalmic Outpatient Surgery Society (OOSS), AAO and ASCRS, we cited Preferences & Trends Survey data showing that more than 70% of responding retina specialists were experiencing difficulty obtaining sufficient OR time, particularly for emergent cases at night or on weekends. We demonstrated that facility reimbursement to the HOPD or ASC is well below the costs of providing many retina procedures—sometimes by several hundred dollars per case—and, therefore, causing facilities to eliminate or reduce retina specialists’ access. As a result, academic and tertiary medical centers are becoming overwhelmed by retina cases that cannot be done in community-based settings.
While CMS did not take any specific action, their recognition of our comments comes at a crucial juncture as ASRS increases advocacy efforts to address the OR access crisis. In addition, this resolution, recently passed by the AMA House of Delegates, is an acknowledgement that helps raise awareness of this growing public health issue.
(Published 11.25.25)