The Centers for Medicare & Medicaid Services (CMS) has released its proposed 2027 Physician Fee Schedule (PFS), outlining Medicare payment changes that could affect glaucoma practices through revisions to same-day evaluation and management (E/M) reimbursement, physician payment rates, and practice expense methodology. The proposed rule would take effect January 1, 2027, following public comment and publication of a final rule.
Among the proposals most relevant to glaucoma surgeons, CMS would reduce payment when a separately identifiable office or outpatient E/M visit is furnished on the same day as a procedure with a 0-, 10-, or 90-day global period. The higher-valued service would be paid at 100%, while additional same-day E/M services or procedures would be reimbursed at 50%. Because many glaucoma procedures—including selective laser trabeculoplasty (SLT), laser peripheral iridotomy, and other office-based interventions—are commonly performed following a same-day evaluation, the proposal could affect a frequent practice workflow. CMS said the change is intended to address what it considers duplicative payment under the current methodology.
The American Glaucoma Society (AGS) said it is concerned the proposal could disrupt patient care by discouraging same-day treatment.“Quality glaucoma care requires a detailed comprehensive consultation which, at times, necessitates same-day laser treatment,” AGS leadership said in a statement.“The proposed CMS 2027 Physician Fee Schedule eliminates fair reimbursement for both aspects of care and may have unintended consequences, including delays in laser treatment, increased patient travel, and reduced efficiencies in the healthcare system with an increased need for staffing. Most importantly, we are very concerned about the overall impact of these policies on patient access to necessary testing and treatment. The American Glaucoma Society will be engaging with CMS on these issues, including providing extensive written feedback during the comment period.”
The proposed rule also would lower Medicare physician payment rates. CMS projects a 2027 conversion factor of $33.17 for qualifying alternative payment model (APM) participants and $32.84 for nonqualifying clinicians, reflecting decreases of 1.19% and 1.68%, respectively, from 2026 after expiration of a temporary statutory payment increase.
Additional proposals include replacing HCPCS code G2211 with a percentage-based modifier that would increase payment for qualifying E/M visits by 16%, with an enhanced modifier available for eligible clinicians participating in certain accountable care organizations. CMS also proposed transitioning its practice expense methodology away from older American Medical Association (AMA) survey data toward more objective, routinely updated cost data and is seeking comments on improving payment accuracy for global surgical services.
“This is difficult news, particularly at a time when physicians are already being asked to do more for patients with less,” the American Academy of Ophthalmology (AAO) commented on its social media accounts. AAO’s advocacy team has reviewed the proposed rule and provided an analysis here. GP