Objective:

To summarize the changes in payment rates for retina surgery under the 2026 OPPS rule by CMS and their implications.

Key Findings:

• Intraocular level 2 and level 3 procedures received increases of 4.97% and 5.69%, respectively, which are above the overall 3.3% increase.
• The APC methodology can lead to disparities in payment, undercompensating complex retinal surgeries.
• 71% of retina specialists reported difficulties in securing operating room time for emergency cases.

Interpretation:

While the increases in payment rates for certain retina procedures are welcomed, the flawed APC methodology continues to create financial challenges for complex surgeries and access to emergency care, potentially impacting patient outcomes.

Limitations:

• APC methodology may not accurately reflect the costs of individual procedures.
• Emergency retina care access is hindered by inadequate reimbursement.
• Changes in payment rates may affect patient outcomes and access to timely care.

Conclusion:

The ASRS and other organizations aim to work with CMS to improve access to emergency retina care and address payment disparities.