What the 2026 CPT Panel Actions Mean for Ophthalmology

The CPT Editorial Panel’s February and May 2026 Summary of Actions offers an early look at where coding and reimbursement are headed, and ophthalmology is clearly part of the conversation.

In this episode, our consultants break down the ophthalmology-related proposals, accepted actions, withdrawn items, and emerging Category III codes discussed by the CPT Panel. Topics include adult goniotomy coding changes, intraocular drug delivery implants, subretinal prostheses, intracapsular magnification devices, minimally invasive glaucoma procedures, and evolving crosslinking HCPCS reporting.

The discussion also explores why Category III codes matter, how CPT Panel actions influence future reimbursement pathways, and what ophthalmology practices should be watching now to prepare for future operational and documentation changes.

Contact us by calling (800) 399-6565 or visiting CorcoranCCG.

Transcript

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Welcome back to another episode of Ophthalmology Reimbursed. I'm Rebecca Greenwald. Good morning, I'm Mary Pat Johnson. Today we're talking about something that may not sound exciting, but it has a major impact on ophthalmology practices over time, and that's the CPT editorial panel summary of actions. Specifically, we're going to discuss the February and May 2026 CPT panel meetings and what those summaries may tell us about the future of ophthalmic coding, emerging technology, and reimbursement trends. This is where we start seeing the future take shape. We see what technologies are gaining traction, which procedures are evolving, areas where documentation expectations are becoming more detailed, and we get a preview of how innovation in eCare is gradually making its way into the coding system. And what's interesting about these summaries is they're not final CPT updates. They are reflections of the discussions at the panel meetings. The code language is not finalized until publication. That's right. And I think that's kind of a key takeaway that a lot of people miss. So practices tend to think about coding changes once a year. And it's usually when the new book is published annually. But discussions of coding and new codes take place throughout the year, especially with category three codes. They're being introduced or at least being considered for new technologies. And those discussions, of course, take place in advance of the publication of the book. So the panel summaries are important because they help us understand what might be coming, what those conversations are focused on. And ophthalmology is always very much part of that because we're an evolving practice. Technology and ophthalmology kind of go hand in hand. So when you look through these most recent summaries, again, February and May, one thing to be that's going to become pretty clear is that within ophthalmology, innovation continues to accelerate. And there's discussions around a lot of different factors, minimally invasive glaucoma procedures, which I know have been the topic for the last couple of years. We're also seeing word of intraocular implants, drug delivery systems, some retinal prostheses, and even some regenerative technologies in the world of eye care. So even when a proposal is withdrawn, and you'll see that one proposal was withdrawn in this recent summary, it does tell us something valuable. It tells us that these technologies are actively being explored and evaluated. And for a reimbursement pathway, they've already started thinking or giving some consideration to codes that would be necessary there. So today, instead of just rattling off a bunch of code changes, we really wanted to talk about these panel actions and what they mean as a broader with a broader view from an ophthalmic perspective. Before we dive into the ophthalmology-specific items, let's spend a minute talking about category three codes because these appear throughout both summaries. Category three codes are temporary CPT codes designed for emerging technologies, procedures, and services. Their purpose is to collect data and track utilization while technology is still evolving. Ophthalmology tends to live in this space quite a bit because other specialty adopts innovation. I'm sorry, because I'm starting that hard over. Ophthalmology tends to live in this space quite a bit because our specialty adopts innovation quickly. And these services often enter the coding system first as category three codes. It's important to remember that each category three code has a sunset date. If utilization doesn't grow or the technology doesn't progress, the code may eventually expire. But if the service continues to gain relevance, the panel can extend or retain the code beyond its original sunset. That's why these panel discussions matter so much. They tell us which technologies appear to be gaining momentum. Agree. And just a couple more points on these category three codes. From an ophthalmology perspective, we do have several of them that are currently active. And some practices tend to misunderstand these. If you look back several years ago, many of the Medicare administrative contractors had bullet policies, full on LCDs, that simply categorized all category three codes together and assigned them a non-covered status. That's no longer the case. So now they're required, each Mac has to look at the code and make a coverage policy for each procedure. We can't blanketly say everything identified with category three is non-covered. So if coverage is uncertain, you must submit a claim and let the payer take a look at it. Now, some coders will view these codes as optional, something they want to avoid because reimbursement is uncertain or inconsistent. Or sometimes we know that it's covered, we know the allowed amount, we just don't like it. So practices may tend to avoid them and opt to bill the patient cash just to get around an unfavorable allowed amount. Again, that's not up to the provider. If there is a code that describes what you do, you need to send it through to test coverage. So lip of view and lip of flow kind of fell into that category for a while. For a long time, they were categorically non-covered, but now that they have to be adjudicated by the claim and an individual decision, we still have a few practices that want to just build a patient cache. So when a code exists, again, whether it's category one or a standard, the standard category one or a category three CPT, we're generally expected to use it. We can't default to an unlisted code. We can't default to billing the patient cache for this. Because remember, this is the pathway to a future standard category one code. We have to have this volume of category threes going through to show that this technology has been accepted. Let's move into some of the ophthalmology-specific developments. Starting with the February 2026 panel summary, probably the biggest ophthalmic item was the acceptance of a new category one code describing goniotomy performed on an adult patient. At the same time, the descriptor for existing code 65820 will be revised so it specifically applies to infants and children's patients under younger than 18. And clinically, this makes complete sense. Historically, goniotomy was associated primarily with pediatric glaucoma treatment. But over the last several years, especially with the growth of MIGs, we've seen cases where surgeons want to do the procedure on an adult patient, but the policy doesn't support it. This coding change reflects how clinical practice has evolved. We must wait and see what the insurers do with the code. Even though the effective date isn't until January 2028, practices should still pay attention now because documentation expectations are clearly becoming more specific. And going forward, there will need to be a clear distinction between pediatric and adult use. I agree. Specificity seems to be kind of constant as a theme across both of these summaries. Coding has become a lot more detailed and nuanced, more reflective of actual clinical differences. So years ago, a broad descriptor as part of the CPT code may have been enough. And if you look back to codes that have been in the book for a while, you see some of their descriptors are quite abbreviated. But now the expectation is to code accurately. And the code has to reflect the patient population, as Rebecca just commented on the patient age, must reflect the technology used, and sometimes even a very specific product being used. Another ophthalmology-related item from February involved is the addition of a new category three code describing insertion of an intracapsular magnification device. And what's interesting here is that we're continuing to see growth in implant-based visual enhancement technologies, especially for low vision and advanced ocular disease management. Yeah, and this too is kind of reinforces how quickly ophthalmic technology is evolving. Beyond IOLs used in cataract surgery or glaucoma surgery that involves implanting of stents, we're now talking about implantable prosthetic systems, some sustained drug delivery systems, and regenerative medicine. So for ophthalmology to adopt these new devices and procedures, there has to be a workable coding and reimbursement process. The February summary also accepted a category three code for describing implantation of a scaffolding allograph. And while this isn't exclusively ophthalmology specific, regenerative and scaffold-based technologies absolutely have implications across surgical specialties, including eye care. This reflects a broader trend toward biologic and tissue support technologies entering mainstream procedural medicine. So in ophthalmology, an example of this scaffolding allograph implantation might be the use of alloflow, which is currently getting some attention within the ophthalmic arena. So let's move on to a corneal nerve function assessment. So moving into the May summary, one of the ophthalmology-related items that stood out was this corneal nerve function assessment. This item was ultimately withdrawn. And Rebecca mentioned earlier the value of knowing about a policy even once it's withdrawn, because we need to know that it was actively being explored clinically and operationally. The corneal nerve assessment is an area that's receiving some growing attention, especially with dry eye disease, some neuropathic corneal pain, even systemic disease correlations and ocular surface diagnostic. But for now, this corneal nerve function assessment, the application submitted to CPT panel, has been withdrawn. Another important ophthalmology item from May was the acceptance of a new category three code describing attachment and insertion of an intraocular drug delivery implant. We're seeing increasing use of sustained release therapies and long-duration implant technologies across retinal disease management and other ophthalmic conditions. So sticking with retina for just a little bit more, one more in the May summary, where we saw that the CPT panel did accept a category three proposed code for the placement of a subretinal prosthesis or subretinal photovoltaic, I think is how you pronounce that, subretinal photovoltaic device. This too is a great example of just how advanced ophthalmic innovation has become. Technologies focused on visual restoration and retinal prostheses are being discussed, as well as areas that were almost futuristic not that long ago. They're progressing far enough for CPT coding pathways to have already been established. We also saw discussions around minimally evasive sclerotomy and insertion of subconjunctival spacer in May's summary, although both items were withdrawn. And as Mary Pat mentioned before, withdrawals don't mean these technologies disappear. It simply means the panel did not move forward with the code adoption at this time. Let's change gears just a little bit and talk Hickspix codes. There's been a little evolution here when it comes to crosslinking. And while we're talking about coding evolution, uh, we should mention that this happening is in both CPT and HiggsPIX. A perfect example is the new code for Epioxa from GuaCOS. So practices who are considering or maybe even performing corneal crosslinking are likely already familiar with the code for riboflavin. So J2787 has been used along with corneal crosslinking to date. But with announcement from GuaCOS and the introduction of Epioxa, we now have new code J2789. There's a lot of discussion about this procedure at the recent ASCRS meeting. So this reflects again that same movement towards specificity and product differentiation. And HicksPix, we're seeing it just as we were seeing it through CPT. Exactly. Coding is becoming increasingly detailed, not just by procedure, but by technology and even by product. Operationally, that means practices need tighter workflows and cleaner documentation. Billing teams, inventory teams, technicians, and physicians all need to be aligned regarding what product was used and how it should be recorded. I agree. This has been very useful. So what we would do at this point is suggest that uh the listener, whether it's the coders, the physicians, kind of step back and look at both of these CPT panel summaries. Again, May and February have been published for 2026. And the message, again, is pretty clear. Ophthalmology continues to be deeply connected with procedural innovation, implant technology, some regenerative medicine, as well as sustained drug delivery evolution. The CPT panel summaries give us an early look at how the coding system is trying to keep the pace up with these advancements. Keep in mind as you read these summaries as well, the new CPT one for goniotomy has an introduction date scheduled for January of 2028. The new Category 3 codes have introduction dates of January 2027. And that's why these summaries matter. Not every proposal becomes permanent. Some are accepted, some are withdrawn, and some eventually evolve into Category 1 codes. But together they tell a story of where medicine and ophthalmology specifically is heading. For practices that want to stay proactive with coding, compliance, and reimbursement preparation, paying attention to these panel discussions is incredibly valuable. You have any questions, please feel free to reach out to us. You can reach us via website at CorcoranCCG.com, or you can give us a call at 1-800-399-6565. We're here to help.