The Centers for Medicare & Medicaid Services (CMS) has finalized its 2027 ambulatory surgery center (ASC) payment rule, lowering the facility rate for vitrectomy despite a positive annual ASC update. The rule takes effect January 1, 2027. 

For vitrectomy billed under Current Procedural Terminology (CPT) code 67036, the final rate is $2,160.65, down from $2,203.87 in 2026, according to the Outpatient Ophthalmic Surgery Society (OOSS). The $43.22 reduction represents a decline of approximately 2.0%. The rate applies to the facility payment, not the surgeon’s professional fee. 

“Even before these cuts, our members were reporting having problems scheduling cases in ASCs,” said Gaurav K. Shah, MD, president of the American Society of Retina Specialists (ASRS). He warned that centers unable to cover surgical costs could decline cases, shifting patients to hospital outpatient departments. 

CMS finalized a 2.3% annual ASC update for facilities meeting quality-reporting requirements. Procedure rates also reflect relative payment weights and budget-neutrality adjustments. In the final rule, CMS retained its exclusion of device costs from ASC payment-weight scaling, leaving the budget-neutrality burden on nondevice portions of surgical payments. 

Separately, CMS’s Physician Fee Schedule fact sheet sets the 2027 conversion factors at $32.95 for qualifying alternative payment model participants and $32.63 for other clinicians. For a separately billable office evaluation and management (E/M) visit furnished by the same physician or practice on the same day as a 0-day global procedure, the more expensive service is paid at 100% and the other service or services at 80%. 

Selected physician payment examples 

Source: Calculated from total relative value units (RVUs) supplied by Elizabeth Cifers, using conversion factors of $33.40 for 2026 and $32.63 for 2027 for clinicians who are not qualifying alternative payment model participants. These illustrative amounts exclude geographic and other claim adjustments, drug payments, and the separate same-day E/M reduction. “Facility” denotes the physician’s professional fee for facility-based care, not the ASC facility payment

Elizabeth Cifers, a retina practice management consultant and Retinal Physician columnist, advised practices to calculate facility and professional payment losses separately, using surgical volume and applicable rates. “If you also own part of the ASC, the impact affects both sides of the business,” she said. She emphasized that the payment change does not relax documentation requirements: a separately billed E/M visit must remain significant and separately identifiable. 

Jill Blim, chief executive officer of ASRS, said the society is working with the Same Day Care Coalition to seek congressional action overturning the same-day payment reduction. ASRS is also seeking extension of the temporary 2.5% conversion-factor increase provided for 2026, she said. 

Blim said ASRS is seeking an ophthalmic emergency activation payment for facilities, modeled on Medicare’s trauma activation policy, to preserve access to emergency surgery. “In parallel, ASRS is pursuing legislation that would direct CMS to establish such a policy,” she said. RP