Medicare Physician Fee Schedule

The Academy believes the Medicare Physician Fee Schedule should ensure financial stability and predictability for all providers. Policy reform is desperately needed to address the foundational problems in the current fee-for-service system and preserve patient access to sight-saving care.

The Academy follows a multi-pronged approach to protect payment to ophthalmologists.

RUC representation

With advisors to the AMA's Relative Value-Scale Update Committee (RUC), the Academy defends and explains work values for ophthalmology procedures. This includes conducting member surveys to gather data on procedure work time and intensity and justifying appropriate payment for newer treatments.

Annual rulemaking engagement

Each summer, the Centers for Medicare & Medicaid Services (CMS) publishes a proposed Medicare Physician Fee Schedule for the following year. The Academy reviews the proposal in detail, submits formal comments, and advocates for changes that protect ophthalmology payment rates. CMS publishes the final rule each fall. The Academy publishes an annual analysis of both the proposed and final rules to keep members informed.

A recent example: the Academy raised serious concerns about CMS's proposed -2.5% efficiency adjustment for 2026, which would reduce work RVUs for nearly 9,000 physician services. While CMS ultimately finalized the adjustment — exempting eye exam codes but not surgical codes — the Academy continues to push back on policies that shift payment away from surgical specialties like ophthalmology.

Legislative advocacy

The Academy works with the AMA, the Surgical Coalition, and other specialty societies to press Congress for fee schedule policies that reflect the true cost of delivering ophthalmic care. In 2026, the conversion factor increased by more than 3% for most ophthalmologists, driven by three factors: a temporary 2.5% increase enacted through the One Big Beautiful Bill Act (OBBBA), a statutory 0.25% or 0.75% MACRA update depending upon APM participation, and a small budget-neutrality adjustment. The Academy supported the legislative effort to secure the 2.5% increase. 

However, that increase is temporary and expires December 31, 2026. The Academy is pressing Congress for a permanent, inflation-linked solution to physician payment.

Since 1992, Medicare has paid health care providers based on an annually updated fee schedule. Payment rates are calculated using the Resource-Based Relative Value Scale (RBRVS), which factors in physician work, direct practice expenses, and the cost of liability insurance. Each component is measured in relative value units (RVUs), allowing Medicare to compare the relative resources required for different procedures and services across specialties.

The AMA's Relative Value-Scale Update Committee advises CMS on physician work values, particularly for new or revised CPT codes. The RUC includes representatives from major specialty societies, including the Academy. Learn more about the RUC process.

Each summer, CMS publishes a proposed rule for the following year's Medicare Physician Fee Schedule. After a public comment period, CMS releases the final rule each fall. The Academy participates at every stage of this annual cycle.

2027 Fee Schedule Highlights for Ophthalmology

The proposed 2027 fee schedule has an estimated 1.68% cut to Medicare payments for physicians who do not participate in Advanced Alternative Payment Models (APMs). CMS proposes a 1.19% cut for qualifying APM participants. 

Both cuts are driven primarily by the expiration of the one-year 2.5% Medicare payment boost for 2026 that was enacted by Congress. The small positive payment adjustments provided by the Medicare Access and CHIP Reauthorization Act (MACRA) and a positive budget neutrality adjustment slightly reduce the cut.

Fee schedule policy changes affect each specialty differently. Ophthalmology faces an over 4% cut to Medicare payments for the coming year according to CMS’ estimates. The effect on an individual ophthalmologist will be determined by the mix of procedures performed and if they participate in an APM.

We need Congress to step in to address the looming cut for 2027. The Academy continues to work with our advocacy partners and Congressional champions to fight for a fix. Read our full analysis.