Adapting to the 2026 CMS Rule: Strategies for Financial Stability and Growth

In the 2026 proposed rule, CMS highlights a potential redistribution of indirect practice expenses from facility to non-facility settings. However, there were no non-facility changes listed for cataract or retina codes. 

The biggest impact to surgeons is the physician reimbursement rates that are continuing to decline across the board.  The proposed Medicare payment rate for cataract code 66984 is $466.87, an 11% decrease from the 2025 Medicare payment of $521.75.   

To maintain financial stability and ensure revenue growth, physicians must explore opportunities beyond Medicare reimbursement. One of the most effective strategies is transitioning to office-based surgery (OBS) settings, which not only enable greater autonomy but also position practices for elective cash-based procedures, such as refractive surgeries. 

By adopting OBS, physicians can take greater control of their surgical processes, improve patient satisfaction, and create new avenues for revenue. We encourage ophthalmologists to evaluate how an OBS model can enhance their financial viability and long-term success in a shifting reimbursement landscape. 

iOR customers are poised to maximize growth opportunities as they have full control over the surgical setting.  Pursuing dual accreditation with optometrists can broaden the scope of procedures they can offer to meet diverse patient needs. Building partnerships with optometrists can drive a steady referral pipeline, ensuring a consistent flow of patients for surgical services. By leveraging both reimbursement models and cash-pay options, practices can strike a balance between financial stability and growth, staying resilient and profitable in an evolving healthcare landscape. 

Thriving in today's competitive healthcare environment requires a proactive and strategic approach. Physicians need to think outside of traditional payor reimbursements.  By implementing OBS and optometric partnerships, surgical practices can diversify revenue streams and position themselves for long-term success. These steps not only enhance patient care but also ensure financial resilience amidst industry changes.