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.
Quality Payment Program and MIPS Changes
The Academy supports CMS’ effort to maintain stability in the Merit-Based Incentive Payment System (MIPS) for the 2026 performance year/2028 payment year. This includes CMS’ proposal to keep the performance threshold at 75 points from the 2026 to 2028 MIPS performance years, which is the score physicians must achieve to avoid a payment penalty. The four performance category weights will also remain unchanged: quality (30 %), cost (30%), promoting Interoperability (25 %), and improvement activities (15%).
However, CMS has reiterated its intent to make MIPS Value Pathway (MVP) reporting mandatory in the future. While the agency has not proposed an official timeline, it has indicated traditional MIPS could sunset by 2029 (2031 payment year).
Currently, ophthalmologists may choose to report via traditional MIPS and select measures most relevant to their practices. They also have the option to report through the new Complete Ophthalmologic Care MVP, which requires physicians to select from a more limited subset of measures.
We remind CMS that ophthalmology is not a homogenous profession, and that the single, specialty-wide MVP disadvantages certain practices by capping the maximum quality score achievable and limiting some subspecialists’ ability to track and improve performance on clinically relevant measures. We urge CMS to keep MVP reporting voluntary, allowing physicians to choose between participating in an MVP or remaining in the traditional MIPS pathway.
We also remind CMS of ongoing problems with the cost performance category, including the lack of timely feedback on the only ophthalmology-specific cost measure for routine cataract removal with intraocular lens (IOL) implantation. If CMS is unable to provide regular feedback on cost performance, it must reweight the cost performance category to 0%.
As a Qualified Clinical Data Registry since 2015, the Academy’s IRIS® Registry (Intelligent Research in Sight) remains the best tool for ophthalmologists to succeed in MIPS. The designation gives the Academy latitude to develop specialty-specific quality measures for MIPS that capture the genuine value of medical and surgical eye care and help participants maximize their MIPS score.
We expect CMS to release the final rule in early November. Stay tuned to Washington Report Express for updates.
