A Blurry Bottom Line: The Economics of Declining Medicare Payment Trends in Ophthalmology Subspecialties, 2003 to 2024.

Ophthalmology is both a procedure driven and high-cost technology intensive area of medicine that commonly treats age related conditions such as cataract and diabetic eye disease which are also some of the most common, high volume, and total dollar billable services in the Medicare program. However, ophthalmologists' payment and financial viability have a delicate financial relationship tied to Medicare reimbursement. This paper examines inflation-adjusted Medicare reimbursement trends across 6 major ophthalmology subspecialties in both facility (eg, inpatient hospital) and non-facility (eg, private practice) settings, and evaluates the contribution of relative value unit (RVU) component values and Medicare conversion factor (CF) to overall payment erosion from 2003 to 2024 using Medicare physician fee schedule data. Ophthalmology-related common procedural terminology (CPT) codes continuously billed to Medicare were classified by 6 major surgical subspecialties: comprehensive, cornea, glaucoma, oculoplastics, pediatric, and retina. Inflation-adjusted Medicare facility (eg, inpatient hospital) and non-facility prices (eg, private practice) were calculated for each CPT code using the Consumer Price Index. Non-facility reimbursement declined more than facility reimbursement across all procedures (-38.9% vs -33.5%, P < .001). Inflation-adjusted Medicare CF declined by 46.9%, while component RVUs remained relatively stable. Decline in ophthalmology reimbursement is primarily driven by sustained reductions in Medicare CF rather than changes in RVU assignments. Retina experienced the steepest decline, showing greater decline in non-facility than facility settings. Medicare payment reforms may be needed to slow reimbursement decline to sustain ocular care delivery, while preserving the long-term financial viability of the Medicare program.