ASCRS Advocates for Ophthalmology Amid Medicare Cuts and Scope of Practice Challenges

As 2025 concludes, the American Society of Cataract and Refractive Surgery (ASCRS) Government Relations Committee remains deeply involved in advocacy on legislative and regulatory issues affecting cataract surgery, ophthalmology, and broader healthcare policies. The year has seen significant challenges including a 2.8% cut to Medicare physician reimbursements, insurer-driven expansions of prior authorization, and ongoing debates around provider scope of practice. ASCRS actively engaged with Congress and regulatory bodies to mitigate these impacts, although full reversal of reimbursement cuts has not been achieved due to stalled legislative negotiations. In 2025, Medicare physician payments faced a 2.8% reduction with efforts such as the Medicare Patient Access and Practice Stabilization Act failing to offset this cut. However, the House-passed reconciliation package acknowledged a need for inflation adjustments in physician pay, setting a precedent for future reform. CMS released the CY 2026 Medicare Physician Fee Schedule Proposed Rule suggesting an 11% cut to cataract surgery reimbursement (CPT code 66984), mainly from efficiency adjustments and changes in indirect practice expense methodology. ASCRS and the Outpatient Ophthalmic Surgery Society highlighted concerns that these adjustments do not reflect specialty-specific data, given ophthalmology’s high rate of private practice. Joint submissions by ASCRS and other ophthalmic societies also addressed the CY 2026 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Proposed Rule, which includes a 5% ASC payment reduction for cataract surgery and an overall 2% decrease in payments for eye surgeries. ASCRS continues to promote a bundled payment model for same-day bilateral cataract surgery to counter CMS’s current policy of a 50% reimbursement reduction for the second eye. Advocacy efforts also extend to opposing scope of practice expansions by non-physician providers, including opposition to legislation that would expand Medicare coverage for chiropractors beyond spinal manipulation, audiologists as Medicare providers, and enhanced pharmacist services under Medicare. ASCRS supports maintaining physician-led, team-based care models to ensure patient safety and care quality. The society also opposed provisions in House legislation capping federal student loans, emphasizing the importance of preserving financial aid pathways for medical education. Conversely, ASCRS supports the Specialty Physicians Advancing Rural Care (SPARC) Act, which incentivizes specialty physicians to practice in rural areas through a loan repayment program. Concerns were also raised about CMS’s Wasteful and Inappropriate Service Reduction Model, expanding prior authorization to Medicare Fee-for-Service with potential impacts on surgical care delivery. Looking ahead to 2026, ASCRS anticipates continued challenges including further Medicare payment reductions, Quality Payment Program refinements, and scope of practice debates. The society encourages member engagement through its Government Relations Committee, annual meetings, and political action committee eyePAC, which supports candidates aligned with ophthalmology priorities. The upcoming 2026 election heightens the importance of robust advocacy funding to influence legislation and protect ophthalmic surgical care delivery under evolving healthcare policies.