The Centers for Medicare & Medicaid Services (CMS) has finalized its calendar year 2027 Medicare Physician Fee Schedule (PFS) with changes to Medicare Part B reimbursement, quality reporting requirements, and accountable care organization (ACO) participation. More specifically for optometry, the cuts will include conversion factor cuts of 2.31% for physicians who are not qualifying Alternative Payment Model (APM) participants and 1.83% for qualifying APM participants.
CMS National Average Nonfacility Pricing National Average:
- CPT code 92014 (Comprehensive Eye Exam) 2026 reimbursement was $127.26; in 2027, reimbursement will be $120.40.
- CPT code 92133 (OCT ONH) 2026 reimbursement was $31.06. It will be $29.37 in 2027.
- CPT code 99203 (low level New pt E/M) 2026 reimbursement was $117.57, and will be $113.55 in 2027.
Announced November 4, the final rule includes a payment reduction for certain services performed on the same day, a transition away from traditional Merit-based Incentive Payment System (MIPS) reporting, and expanded incentives for coordinated and preventive care. The rule takes effect January 1, 2027.
Changes to Same-Day Billing
Among the payment changes, CMS will reduce reimbursement by 20% for the lower-cost service when an evaluation and management (E/M – 992XX) visit and minor procedure with a 0-day global are performed on the same day. CMS has decided to exclude 10-day global procedures, but it will include a 20% reduction on (E/M) visits when paired with modifier -25 for minor procedures with 0-day global (see sidebar for examples).
The agency says this adjustment is intended to prevent duplicate payment for clinical work already included in procedure valuations.
Examples of Services with a 0-Day Global Period:
- CPT code 65220 Removal of foreign body, external eye; corneal, with slit lamp.
- CPT code 65778 Placement of amniotic membrane on the ocular surface; without sutures.
CMS is also modifying its fee schedule rate-setting methodology to reflect the resources and complexity associated with medical services.
MIPS Reporting Changes
CMS finalized plans to discontinue the traditional MIPS reporting option beginning with the 2031 performance period. Clinicians will have through 2030 to transition to MIPS Value Pathways (MVPs) or Advanced Alternative Payment Models. The transition period is 2 years longer than originally proposed. Existing MVPs cover approximately 98% of clinicians. The final rule establishes 3 additional pathways focused on diabetes, hypertension, and hospitalists.
Beginning with the 2027 performance period, clinicians will also be required to report at least 1 specialty-specific Core Measure under the applicable quality reporting requirements
Changes to Accountable Care Organizations
The final rule expands opportunities for ACOs participating in the Medicare Shared Savings Program. Beginning April 1, 2027, approved ACOs may reduce or eliminate Medicare Part B cost-sharing for many items and services provided to assigned beneficiaries to lower the cost of out-of-pocket essential services.
CMS is also increasing shared savings rates for eligible ACOs, which will introduce incentives for first-time participants and simplify electronic health record reporting and patient notification requirements.
During the 2024 performance year, 75% of the program's 476 participating ACOs earned shared savings totaling $4.1 billion. The program generated approximately $2.5 billion in net savings for Medicare trust funds compared with projected spending benchmarks.
The 2027 Medicare Physician Fee Schedule final rule takes effect January 1, 2027. Additional information is available in the CMS announcement.