Contract intelligence
Structure payer products, fee schedules, Medicare tiebacks, and effective dates in one usable model.
Practice financial intelligence
Fulcrum for Ophthalmology.
See how every contract, payment, and service line performs. Connect exams, diagnostics, injections, and surgery to the contracts and payer products that price them.
Financial visibility for Ophthalmology
Diagnostics, drugs, procedures, and surgery create very different reimbursement profiles.
Fulcrum gives ophthalmology finance teams a product-level view of expected payment, contract changes, and unit economics across the services that drive the practice.
One connected intelligence layer
Built for the questions your finance team actually has.
Payment monitoring
Detect and investigate potential underpayments in an automated, accurate way.
Forecasts & negotiations
Test proposed rates against actual volume and bring clear evidence into payer conversations.
Service-line economics
Integrate encounter and cost data to see precise unit economics for specific CPT codes.
What becomes answerable
Move from reported revenue to financial context.
- 01Which payer products are underperforming?
- 02Which payments do not match the contract?
- 03How will a proposed rate change affect revenue?
- 04Which services produce the strongest unit economics?
CY 2027 proposed PFS
What the proposed rule could mean for Ophthalmology.
A national specialty average is useful context, not a practice forecast. Your result depends on your codes, volume, locality, sites of service, and Medicare-linked contracts.
-2.9%CMS specialty estimate
-3.2%Fulcrum reconstruction
CMS's projected overall impact for Ophthalmology
CMS's own reconciliation table (Table D-B5) puts ophthalmology at -2.9% for 2027. That figure is the specialty-wide, volume-weighted change in total RVU-based allowed charges: the aggregate gain or loss across every code the specialty bills, before the separate conversion-factor cut. Our reconstruction agrees closely at -3.2%, a net reduction of $147 million in national allowed charges.
Ophthalmology bills about 74% of its Medicare dollars in the office (non-facility) setting. By site of service, the 2027 change splits as follows:
| Site of service | Change | Allowed $ |
|---|---|---|
| Office (non-facility) | -3.6% | -$121M |
| Facility | -2.3% | -$27M |
All figures are national, hold 2025 utilization fixed, and exclude the separate 1.68% conversion-factor cut that lands on every specialty on top of this.
The average hides the practice-level spread.
How Fulcrum models the PFS →
The specialty average hides a wide spread, and CMS's own practitioner-level file proves it. 41% of ophthalmology practitioners land in the -2 to -1% band, and about 35% see a cut deeper than 2%. Where a practice lands is a question of service mix: the ophthalmology practices hit hardest are those with the most high-overhead office imaging and testing, plus cataract volume.
Practice-specific analysis
See what your contracts and service mix say.
Start with one contract, one fee-schedule question, or an ongoing view across the practice.