To analyze the impact of the 2026 Medicare updates on ambulatory surgical centers (ASCs) and physicians, focusing on reimbursement changes, payment increases, and prior authorization requirements.
Key Findings:
Physician reimbursement for ASC procedures is expected to decrease due to a new indirect practice expense methodology, which reallocates funds away from ASC services.
A -2.5% adjustment to work RVUs for most non-time-based CPT codes will lower work values for many core services, affecting the overall income for physicians.
Ophthalmic procedures in ASCs will see facility rate increases of about 1% to 10%, with significant increases for specific procedures, providing some financial relief.
Interpretation:
The 2026 updates present a mixed environment for ASCs, with improvements in facility payments for ophthalmology but overall tighter professional reimbursements for physicians, necessitating strategic adjustments.
Limitations:
The new prior authorization requirements may complicate workflows and delay payments, increasing administrative burdens.
The adjustments to reimbursement rates may not fully account for the costs associated with high-cost devices and drugs, potentially impacting service delivery.
Conclusion:
ASCs should prepare for reduced physician payments and reassess profitability while integrating prior authorization processes to ensure timely payments, possibly by investing in administrative support.
We’ve come out of a year that showed solid growth for many ASCs, and—in no small part due to the hard work of OOSS leadership—we will enjoy another increase in cataract surgical fee reimbursement this year.
