ASCRS News: Government Relations Update
Winter 2025
by Susanne Hewitt, MD
ASCRS Government Relations Committee Chair
As 2025 concludes, ASCRS Government Relations staff and the ASCRS Government Relations Committee remain actively engaged in legislative and regulatory advocacy impacting cataract surgery, ophthalmology, and broader healthcare policy. Key issues this year included cuts to physician reimbursement under Medicare, regulatory restructuring, and insurer-driven expansions of prior authorization and scope of practice.
Looking ahead to 2026, ASCRS anticipates continued challenges, including further Medicare payment reductions, refinements to the Quality Payment Program, and ongoing scope of practice debates. ASCRS will continue advocating for fair reimbursement, including support for same-day bilateral cataract surgery and coverage for innovative technologies and procedures. With healthcare policy continuing to shape the delivery of ophthalmic care, ASCRS Government Relations, the ASCRS political action committee (eyePAC), and our members’ engagement in advocacy will be important to protect your practice and ensure access for all patients to high-quality eyecare.
Medicare reimbursement
As the year began, physicians experienced a 2.8% cut to the physician fee schedule. ASCRS worked with Congress to address this cut, but unfortunately, a year-end continuing resolution to fund the government failed, and language providing a partial physician pay fix was removed, allowing the full 2.8% cut to take effect on January 1. Despite ASCRS efforts, including support for the Medicare Patient Access and Practice Stabilization Act of 2025, legislation that would fully offset the 2.8% Medicare reimbursement cut, the cut remains in effect due to stalled legislative negotiations.
Language addressing the cut was included in the House-passed reconciliation package but was removed by the Senate before final passage in July. While not addressing the 2.8% cut to the Medicare Physician Fee Schedule conversion factor that went into effect on January 1 of this year, the Medicare provisions approved by the House provided a positive payment update of 75% of the Medicare Economic Index for 2026. This is the first time Congress acknowledged the need for an inflation update for physician pay under Medicare, an important precedent. We continue to pressure Congress to address the current cut and to reform Medicare physician pay moving forward.
Medicare Physician Fee Schedule Proposed Rule
In July, CMS released the CY 2026 Medicare Physician Fee Schedule Proposed Rule. The rule proposes major changes in reimbursement for physicians. ASCRS, joined by the Outpatient Ophthalmic Surgery Society (OOSS), submitted comments on the proposal. Most concerning to ASCRS is that cataract surgery, CPT code 66984, is facing an 11% cut, driven by a flawed 2.5% efficiency adjustment to the Work RVUs and changes to the indirect practice expense methodology. ASCRS maintains that the RUC provides fair and accurate valuations for procedure codes, especially those related to cataract and other ophthalmic surgeries. In addition, CMS’ proposed changes to the indirect practice expense methodology overlook critical specialty-specific data. While CMS cites a broad shift toward hospital-based care, ophthalmology remains an outlier, with 70.4% of ophthalmologists still in private practice, according to the AMA’s 2024 Policy Research Perspectives. ASCRS is working with other specialty societies on a strategy to approach Congress should these proposals remain in the final rule.
ASC Payment Proposed Rule
CMS also released the CY 2026 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center (ASC) Payment Proposed Rule. ASCRS, AAO, ASRS, OOSS, and SEE submitted joint comments on the proposal. The chief concern addressed in the comments is the proposed reduction in the ASC payment rate for cataract surgery, CPT 66984. Payment for this procedure is estimated to decrease by 5% of the CY 2025 payment rate of $1,371. Overall, CMS proposes a 2% decrease in eye surgical procedure payments.
Same-day bilateral cataract surgery
ASCRS continues to promote its bundled payment model for same-day bilateral cataract surgery, engaging with federal regulators at CMMI and CMS to eliminate the current 50% reimbursement reduction for the second eye. Discussions continue as we work toward policies that will allow physicians to bill in traditional Medicare.
Broader healthcare policy
ASCRS joined with other medical specialty societies to bring attention to other issues impacting healthcare. As part of the Alliance of Specialty Medicine, ASCRS provided comments to the authors of draft legislation in the Senate and House addressing reforms to Graduate Medical Education. The Alliance and ASCRS also sent letters in support of legislation that would reform prior authorization procedures in Medicare and Medicare Advantage by requiring prior authorization decisions be made by board-certified physicians in the same specialty as the physician of the treatment or disease in question. ASCRS and the Alliance of Specialty Medicine also submitted comments to the U.S. Department of Justice Anticompetitive Regulations Task Force Public Inquiry, commenting on unnecessary laws and regulations that raise barriers to competition and encourage consolidation in the healthcare market.
Scope of practice
Non-physician providers continue to press for an expanded scope of practice. ASCRS joined with other medical societies to express opposition to these efforts.
ASCRS, along with the AMA and more than 90 national and state medical societies, sent a letter to the lead sponsors of S. 106/H.R. 539, the Chiropractic Medicare Coverage Modernization Act of 2025, expressing strong opposition to the bill. The legislation would amend the Social Security Act’s definition of physician to extend Medicare coverage for services furnished by chiropractors beyond the manual manipulation of the spine.
ASCRS joined national, state, and local medical specialty societies on a letter to the leadership of the House Ways and Means and Energy and Commerce Committees opposing the Medicare Audiology Access Improvement Act (H.R. 2757), which would reclassify audiologists as Medicare providers and expand their scope of practice beyond their educational training and clinical competencies, undermining the physician-led, team-based approach that ensures comprehensive care for patients.
ASCRS joined the AMA and more than 80 national and state medical associations in a letter to the House and Senate sponsors of the Ensuring Community Access to Pharmacist Services (ECAPS) Act, expressing opposition to the bill, which would allow pharmacists to perform services that would normally only be authorized and covered if they were furnished by a physician, testing and treating patients for certain illnesses, and expanding Medicare payment for pharmacists in limited but significant ways.
These efforts aim to preserve physician-led, team-based care.
Student loan reform
ASCRS joined other societies opposing a provision in the House reconciliation bill capping federal student loans. The bill language caps federal student loans at $50,000 for undergraduate programs, $100,000 for graduate student programs, and $150,000 for professional programs. After passing in the House, ASCRS joined 50 healthcare organizations, representing medical students, residents, practicing physicians, and medical schools, urging the Senate to protect financial aid programs that improve access to medical education by changing proposals within the One Big Beautiful Bill Act passed by the House.
ASCRS, along with 37 physician organizations, sent a letter to the House and Senate sponsors of the Specialty Physicians Advancing Rural Care (SPARC) Act (S. 1380/ H.R. 4681), expressing strong support for the legislation, which would establish a new loan repayment program to incentivize specialty physicians to practice in rural communities.
Prior authorization
ASCRS and the Surgical Coalition, representing physicians involved in the delivery of surgical care to Medicare beneficiaries, sent a letter to CMS Administrator Mehmet C. Oz, MD, MBA, expressing deep concerns with the Wasteful and Inappropriate Service Reduction Model expanding prior authorization in the Medicare Fee for Service program. The current model will run for 6 years starting in January 2026. The program will run in six states and will focus on services that 1) may pose patient safety concerns if delivered inappropriately, 2) have existing coverage criteria, and 3) may involve prior reports of fraud, waste, and abuse.
2026 engagement
These and other issues are sure to come up in 2026. The ASCRS Government Relations Committee and ASCRS Government Relations staff will remain vigilant in monitoring and responding to policy developments. ASCRS member advocacy will be critical. The ASCRS Annual Meeting, taking place in Washington, D.C., in April, is a great opportunity to hear about the healthcare issues dominating discussions in our nation’s capital and to talk with legislators and regulators about the unique challenges faced by ophthalmology and anterior segment surgeons. The Alliance of Specialty Medicine Annual Fly-In in July is also a great way to get involved in advocating for our patients and our profession. Contact me at [email protected] or ASCRS Director of Government Relations Mark Cribben at [email protected] if you are interested in getting involved with the Government Relations Committee.
Support eyePAC
You can also help with these efforts by supporting eyePAC, the first ophthalmology-focused political action committee. Your contribution strengthens our advocacy efforts, helps us build relationships with key congressional health committee members, and enables us to support candidates who champion your priorities. Your support of eyePAC directly fuels our fight to protect cataract surgery and preserve your ability to deliver high-quality care. In 2025, ASCRS members contributed more than $118,000 to eyePAC. As we enter the important election year of 2026, eyePAC needs the resources to get our message to Congress. The more funds we have, the more we can help current legislators who support our issues and support physicians and physician-friendly candidates running for the first time.
Contact
Hewitt: [email protected]
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