Eye care · Medicare · CY2027 PFS final rule
The 2027 fee schedule cuts eye care on every line, not just one.
CMS finalized the CY2027 Physician Fee Schedule (CMS-1848-F) on 4 November 2026. The conversion factor falls 2.31%, ophthalmology and optometry lose about 3% more from RVU changes, and a new same-day E/M reduction reaches retina clinics. Here is what changes by code, and what to fix before 1 January.
By ASP-RCM Editorial, Healthcare RCM Practice · Updated
2027 conversion factor (non-QP)
Down 2.31% from $33.4009. The qualifying APM factor is $32.95, down 1.83%.
Ophthalmology RVU impact
CMS specialty impact file. This sits on top of the conversion factor drop.
Optometry RVU impact
Same CMS file. Non-facility optometry services also show -3%.
Same-day payment on the lower service
O/O E/M with a 0-day global procedure. CMS proposed 50% and finalized 80%.
Top eye codes: 2026 vs 2027 national Medicare amounts
National, unadjusted, non-qualifying APM amounts. Your locality will differ by GPCI, but the percentage change is close. Office means non-facility.
| Code | Service | Setting | 2026 | 2027 | Change |
|---|---|---|---|---|---|
| 92014 | Comprehensive eye exam, established | Office | $127.26 | $120.40 | -5.4% |
| 92004 | Comprehensive eye exam, new | Office | $149.64 | $142.26 | -4.9% |
| 92012 | Intermediate eye exam, established | Office | $90.52 | $85.49 | -5.6% |
| 99214 | Office visit, established, moderate | Office | $135.61 | $131.17 | -3.3% |
| 67028 | Intravitreal injection (0-day global) | Office | $114.23 | $108.65 | -4.9% |
| 92134 | OCT, retina | Office | $32.73 | $31.00 | -5.3% |
| 92133 | OCT, optic nerve | Office | $31.06 | $29.37 | -5.4% |
| 92083 | Visual field, extended | Office | $63.80 | $60.04 | -5.9% |
| 92250 | Fundus photography | Office | $37.07 | $35.24 | -4.9% |
| 66821 | YAG capsulotomy | Office | $335.35 | $316.82 | -5.5% |
| 66984 | Cataract with IOL | Facility | $462.60 | $442.12 | -4.4% |
| 66982 | Complex cataract with IOL | Facility | $630.94 | $602.65 | -4.5% |
| 66991 | Cataract with IOL and MIGS | Facility | $582.18 | $556.64 | -4.4% |
92014, 92012, 99214, 66821 and 66984 are CMS's own figures from the final rule's Impact on Payment for Selected Procedures file. The other rows are total RVUs from the CY2026 and CY2027 final Addendum B times each year's conversion factor ($33.4009 and $32.6286).
Diagnostic and exam codes fall the most
Percentage drop in the national office amount, 2026 to 2027. Work RVUs for these codes did not change. The cut comes from practice expense and the conversion factor.
Source: CMS CY2027 PFS final rule Addendum B and Impact on Payment for Selected Procedures file. Before the same-day E/M reduction, which applies on top.
How the same-day E/M reduction works from 1 January 2027
CMS finalized a narrower version of the July proposal. It also says it will watch for visits moved to another day to avoid the cut.
Same day, same group
An office or outpatient E/M (99202-99205, 99211-99215) is billed with a 0-day global procedure by the same practitioner, or one of the same specialty in the same group.
Rank the services
The highest-paid service on that day is paid at 100%.
Reduce the rest
Every other service that day, procedure or E/M, is paid at 80%. The proposal was 50%.
Monitoring follows
CMS names claims edits, comparative billing reports and medical review to catch scheduling done to avoid the reduction.
What the final rule reaches, and what it does not
Scope is set by the code list in the final rule. Coding must still follow the documentation, not the payment result.
In scope from 1 January
- 99202-99215 billed with modifier -25 on the same day as a 0-day global procedure
- 67028 intravitreal injection, a high-volume 0-day code
- Other 0-day eye procedures such as 67516 and 68841
- Same practitioner, or same specialty in the same group
Not named in the final policy
- Eye exam codes 92002-92014 (the final code list names only 99202-99215)
- 10-day globals such as 68761 punctal plug
- 90-day globals such as 66984 cataract and 66821 YAG
- Diagnostic tests with no global period, such as 92134 OCT
Worked example: 99214 plus 67028, same day, office
An illustration built only from CY2027 national Medicare amounts. It is not a client result. The drug line is billed and paid separately and is not part of this calculation.
| Line | 2027 national amount | Paid under the final rule | Difference |
|---|---|---|---|
| 99214-25 office visit | $131.17 | $131.17 (highest-paid, 100%) | $0.00 |
| 67028 intravitreal injection | $108.65 | $86.92 (80%) | -$21.73 |
| Encounter total | $239.82 | $218.09 | -$21.73 |
| Same day with 99213-25 instead | $92.01 + $108.65 | $73.61 + $108.65 (67028 is now the higher service) | -$18.40 |
Coinsurance follows the reduced allowed amount. Multiply the per-encounter difference by your annual count of same-day E/M plus injection encounters to size your own exposure.
Three other changes that touch eye care claims
B1 replaces G2211
G2211 ends. Modifier B1 adds 16% to the O/O E/M base code. It stays unpayable when the E/M carries -25, except with preventive services, AWVs or vaccines.
Eye codes do not take B1
B1 attaches to office/outpatient and home E/M codes. Glaucoma and retina follow-ups billed as 92012 or 92014 get no add-on.
A second PE step in 2028
CMS removes the indirect practice cost index over two years: half the effect in 2027, fully gone in 2028. Expect more practice expense pressure next year.
Key dates
- 4 Nov 2026
CMS-1848-F final rule on public display; fact sheet released.
- 9 Nov 2026
Final rule publishes in the Federal Register.
- 1 Jan 2027
New conversion factor, RVUs, same-day E/M reduction and modifier B1 take effect. G2211 stops.
- 1 Jan 2028
IPCI fully removed from the practice expense method.
Before 1 January: is your eye group ready?
Tick what is already done.
2027 is a broad Medicare cut for eye care: about 2.3% from the conversion factor plus about 3% from RVUs, and up to 20% off the lower-paid line on same-day E/M with an injection. Load the new rates, size the same-day exposure by provider, and keep code selection tied to the chart.
Questions operators ask next
What is the 2027 Medicare conversion factor?
Under the CY2027 final rule (CMS-1848-F) the non-qualifying APM conversion factor is $32.6286, down 2.31% from $33.4009 in 2026. The qualifying APM factor is $32.95, down 1.83%. CMS says the drop mainly reflects current law, because the one-year 2.5% increase for 2026 expires. The new factors apply to services on or after 1 January 2027.
Does the 2027 modifier 25 reduction apply to eye exam codes 92002-92014?
The final rule applies the reduction to office/outpatient E/M codes 99202-99205 and 99211-99215 billed on the same day as a 0-day global procedure. The eye exam codes 92002-92014 are not on that list. CMS also warned it will monitor billing patterns, so exam code selection must follow the documentation and CPT rules, not the payment result.
What replaces G2211 in 2027?
CMS ends separate billing of G2211 and replaces it with modifier B1, which raises payment for the associated office/outpatient or home E/M code by 16%. Modifier B2 adds 32% but only for Shared Savings Program ACO and LEAD model participants. As with G2211, the add-on is not payable when the E/M carries modifier -25, except with preventive services.
How much will ophthalmology Medicare payments fall in 2027?
CMS's specialty impact file shows -3% for ophthalmology and -3% for optometry from RVU changes. That figure excludes the statutory conversion factor change, so the combined national effect is roughly 5%, before locality and mix. Many high-volume eye codes fall 4% to 6%, as the code table above shows.
Want your 2027 Medicare exposure by code and by site?
Send us 90 days of eye care claims and remits. A senior ophthalmology billing lead maps your exam, imaging, injection and surgery volume to the 2027 final rates and the same-day rule, in a free 30-minute call with a written gap report after.
Keep reading
Sources
- CMS fact sheet, CY2027 Medicare Physician Fee Schedule final rule, 4 Nov 2026
- CMS, CMS-1848-F rule page: Addendum B, specialty impact and selected procedures files
- Federal Register public inspection, CY2027 PFS final rule (2026-22743)
- CMS, CY2027 PFS final rule estimated impact by specialty (updated 5 Nov 2026)
- CMS, CY2027 PFS final rule impact on payment for selected procedures
Checked November 6, 2026. Amounts are national and unadjusted; your MAC locality, contracts and payer mix change the result. CPT codes are copyright American Medical Association. General information, not legal or coding advice.