Most optometrists will see a 2.5% payment boost in 2026 under the Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule. The pay increase, part of the recently released final rule, is set to take effect on Jan. 1 and reverses a previously anticipated reduction.
The pay update reflects successful last-minute advocacy by the American Optometric Association (AOA) and other physician organizations, whose efforts secured the increase. In a press release, the AOA said this measure lays groundwork for future reforms that would align pay increases with inflation on an annual basis.
Along with the pay increase, CMS finalized other provisions that impact Medicare pay and several other policy changes.
Telehealth Gains Permanent Status
CMS will add services to the Medicare Telehealth List on a permanent basis, eliminating the previous distinction between “provisional” and “permanent” coverage categories. The AOA said it supported this proposal, which simplifies the process for including new telehealth services.
Facility-Based Service Cuts
CMS finalized a reduction in payment rates for services performed in facilities such as hospitals and ambulatory surgical centers. Beginning in 2026, facility practice expense relative value units (RVUs) will drop to half the rate allocated for non-facility settings. The AOA and other physician groups raised concerns this proposed rule.
Efficiency Adjustment and Exemptions
CMS will apply a 2.5% decrease, being described as an “efficiency adjustment,” to work RVUs and intraservice time. This will affect nearly 9,000 services that are expected to see gains in efficiency due to technological and practice improvements. Eye exam codes and all evaluation and management visits are exempt from the adjustment.
MIPS and Quality Program Updates
The Merit-based Incentive Payment System (MIPS) threshold to avoid a 9% penalty remains at 75 points. MIPS-eligible clinicians must adhere to updated cybersecurity requirements, such as maintaining an inventory of connected devices and performing a security risk assessment.
Other updates include changes to glaucoma and diabetic eye exam measures and a two-year feedback period for new cost measures.