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Don't edit this page - Academy Pushes Back on CMS’ Harmful Proposals in Formal Comments

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The Academy submitted comments to the Centers for Medicare & Medicaid Services (CMS) on Sept. 10, expressing ophthalmology’s concerns and providing recommendations regarding the 2026 Medicare Physician Fee Schedule proposed rule.

Developed after gathering member feedback, our comments highlight the risk of significant disruptions to practices and the downstream consequences for patient care posed by CMS’ unprecedented proposals affecting surgical services in ophthalmology.

Our 28-page letter covers a broad range of issues in the proposed rule, including:

Two conversion factors starting in 2026

Two significant proposals for surgical care

Reductions to practice expense for the facility setting

New -2.5% efficiency adjustment to nearly all procedures

Inaction on global surgical code payment equity

Changes to the Quality Payment Program and Merit-Based Incentive Payment System (MIPS)

We encourage members to review the document (PDF).

In addition to our formal letter, the Academy launched a multipronged advocacy campaign to fight these proposals. To amplify our message, we initiated a grassroots campaign that individual Academy and AAOE® members used to submit comments to CMS. State ophthalmology and specialty interest societies were also provided letter-writing resources to support their advocacy efforts. We greatly appreciate everyone that responded to the Academy’s call to action. Nearly 700 individual members submitted comments to CMS.

2026 Conversion Factor

As a result of CMS incorporating the 2.5% conversion factor (CF) increase provided by Congress in the One Big Beautiful Bill Act (P.L. 119-21), the proposed CF for qualifying advanced payment model participants is $33.59, an increase of $1.24 (3.8%) from the 2025 Medicare Physician Fee Schedule (MPFS) CF of $32.35. The proposed 2026 CF for all other clinicians is $33.42, an increase of $1.07 (3.3%) from the 2025 CF of $32.35.

It is important to acknowledge that the 2.5% increase is temporary and will expire on Dec. 31, 2026. We urge CMS to engage with Congress as it works to ensure appropriate physician reimbursement, improve the Medicare payment system, and provide continued stability for physician practices and their patients.

The boost to the conversion factor masks two very concerning policies that could unfairly drive down reimbursement for all surgeons and services provided in the facility setting in the near- and long-term.

Reductions to Practice Expenses for Facility Setting

Currently, the indirect practice expense (PE) of any service is the same whether performed in the facility (e.g., HOPD, ASC) or nonfacility (e.g., office) setting. CMS believes this incentivizes consolidation and is proposing a change to cut practice expense relative value units (RVUs) when services are performed in a facility. This proposal makes broad assumptions about physician employment trends that are not representative of ophthalmology and could drive further consolidation of the U.S. health care system if finalized.

We urge CMS to fully withdraw implementation of the proposed indirect PE methodology refinements until more robust empirical data can be collected and analyzed, the specialty- and procedure-specific impacts can be further evaluated, and a more targeted approach developed that avoids inflicting collateral damage, particularly on independent practice.

New -2.5% Efficiency Adjustment to Nearly All Procedures

CMS believes that gains in physician work efficiency have accrued over time and are not adequately reflected in current code values. To address its concerns that some codes are overvalued, the agency proposed to apply an efficiency adjustment to the intraservice portion of physician time and corresponding work relative value units (RVUs) for nearly all non-time-based codes, such as procedures, radiology services, and diagnostic tests.

The Academy strongly opposes CMS’ proposal to implement an efficiency adjustment due to its many flawed assumptions about the rate of efficiency gains related to physician work and technology, and its harmful implications for patient safety and code value accuracy.

The proposed efficiency adjustment, which assumes that gains in efficiency are continuously increasing, puts physician practice operations and patient safety and quality of care at risk. We insist that CMS not implement this unfair policy in the final rule.

Global Surgical Codes

It is disappointing that CMS has again refused to implement global surgical code payment equity in the 2026 Medicare Physician Fee Schedule proposed rule. The failure to adjust global codes amounts to paying some physicians less for providing the exact same level of evaluation and management (E/M) services and the agency’s decision not to apply the payment update to global surgical codes runs directly contrary to federal law and the intent of Congress.

Instead of offering a solution to address global surgical post-operative visit reimbursement inequity, CMS is seeking comments on strategies to improve the accuracy of payment for global surgical packages, specifically related to the updated transfer of care policy.

We recommend utilizing the well-established and widely accepted RUC misvalued codes process, which allows input from all stakeholders involved in the valuation process, including CMS. Additionally, we urge the agency to fully restore relativity and sustainability to the payment system by applying the 2021 valuation of the inpatient hospital and observation care visits (99231-99233, 99238 and 99239), and office visits (99202-99215) to the post-operative portion of surgical global packages.