{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:46:09Z","timestamp":1792032369487,"version":"4.4.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of VitreoRetinal Diseases"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    <jats:bold>Purpose:<\/jats:bold>\n                    To compare the Medicaid and Medicare physician reimbursement rates for the top 10 most common vitreoretinal surgeries.\n                    <jats:bold>Methods:<\/jats:bold>\n                    The Medicaid-to-Medicare reimbursement ratios were compared for the most frequently used Common Procedural Terminology (CPT) codes, adjusted for each state\u2019s proportion of Medicaid enrollment in the United States.\n                    <jats:bold>Results:<\/jats:bold>\n                    The most used CPT codes were 67042 (26%), 67036 (20%), 67108 (17%), 67041 (11%), 67113 (11%), 67040 (6.5%), 67039 (4.1%), 67121 (2.8%), 67218 (0.44%), and 67107 (0.43%). The weighted average (\u00b1SD) of the Medicaid reimbursement rate was 88% \u00b1 2.3% of the Medicare rates. New Jersey had the lowest Medicaid-to-Medicare ratio (52% \u00b1 2.33% of all Medicaid enrollees). Thirty-six states, comprising 80% of all US Medicaid enrollees, had lower Medicaid than Medicare rates; 30 of those states had lesser-of policies, under which physicians would be reimbursed at the lower Medicaid rates despite patients being dually enrolled in both Medicaid and Medicare.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    There were significant variations between states, but Medicaid reimbursements were on average 12% lower than Medicare rates. In most states, there was a significant opportunity cost for the physician performing the same surgery on a patient with Medicaid compared with Medicare. State governments should work to improve patient access to care, match the Medicaid and Medicare rates, and eliminate lesser-of payment policies.\n                  <\/jats:p>","DOI":"10.1177\/24741264261440803","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T02:39:13Z","timestamp":1778207953000},"page":"1023-1028","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Medicaid Vs Medicare Reimbursement Rates for Vitreoretinal Surgeries in the United States"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4874-2471","authenticated-orcid":false,"given":"Ella H.","family":"Leung","sequence":"first","affiliation":[{"name":"Georgia Retina, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6640-6869","authenticated-orcid":false,"given":"Ghassan","family":"Ghorayeb","sequence":"additional","affiliation":[{"name":"West Virginia University Eye Institute, Morgantown, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6681-6104","authenticated-orcid":false,"given":"Nimesh","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Blim","sequence":"additional","affiliation":[{"name":"American Society of Retina Specialists, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6114-0996","authenticated-orcid":false,"given":"Hasenin","family":"Al-khersan","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9522-8486","authenticated-orcid":false,"given":"Miguel","family":"Busquets","sequence":"additional","affiliation":[{"name":"Retina Associates of Kentucky, EyeCare Partners, Lexington, KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton M.","family":"Kolomeyer","sequence":"additional","affiliation":[{"name":"NJRetina, Lawrenceville, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Niles","sequence":"additional","affiliation":[{"name":"Buffalo Niagara Retina Associates, Buffalo, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avni P.","family":"Finn","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Vanderbilt University, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco A.","family":"Folgar","sequence":"additional","affiliation":[{"name":"Carolina Eyecare Physicians, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0144-3319","authenticated-orcid":false,"given":"Michael","family":"Javaheri","sequence":"additional","affiliation":[{"name":"Retina Specialists of Beverly Hills, Beverly Hills, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey G.","family":"Emerson","sequence":"additional","affiliation":[{"name":"Retina Consultants of Minnesota, Minneapolis, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"Lai","sequence":"additional","affiliation":[{"name":"The Retina Group of Washington, Chevy Chase, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"CDC. Medicaid - Health United States 2025. Accessed August 30 2025. https:\/\/www.cdc.gov\/nchs\/hus\/sources-definitions\/medicaid.htm"},{"key":"e_1_3_2_3_2","unstructured":"MACPAC. Provider payment and delivery systems. Accessed December 13 2025. https:\/\/www.macpac.gov\/medicaid-101\/provider-payment-and-delivery-systems\/"},{"key":"e_1_3_2_4_2","unstructured":"Medicare.gov. Parts of Medicare. Medicare. Accessed September 1 2025. https:\/\/www.medicare.gov\/basics\/get-started-with-medicare\/medicare-basics\/parts-of-medicare"},{"key":"e_1_3_2_5_2","unstructured":"Centers for Medicare & Medicaid Services. Federal Register: Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Pricing Data Release; Medicare Advantage and Part D Medical Low Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Mode. Published online July 15 2016. Accessed September 1 2025. https:\/\/www.federalregister.gov\/documents\/2016\/11\/15\/2016-26668\/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2024.01530"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0046958019838118"},{"key":"e_1_3_2_8_2","unstructured":"MACPAC. Evaluating the effects of Medicaid payment changes on access to physician services. January 2025. Accessed September 1 2025. https:\/\/www.macpac.gov\/wp-content\/uploads\/2025\/01\/Evaluating-the-Effects-of-Medicaid-Payment-Changes-on-Access-to-Physician-Services.pdf"},{"key":"e_1_3_2_9_2","unstructured":"Centers for Medicare & Medicaid Services. Part B National Summary Data File. 2026. Accessed December 13 2025. https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Downloadable-Public-Use-Files\/Part-B-National-Summary-Data-File\/Overview"},{"key":"e_1_3_2_10_2","unstructured":"TennCare. TennCare Medicaid. Accessed September 1 2025. https:\/\/www.tn.gov\/tenncare\/members-applicants\/eligibility\/tenncare-medicaid.html"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13545"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.11.065"},{"key":"e_1_3_2_13_2","unstructured":"Department of Health and Human Services. DHHS explains Medicaid rate adjustment in response to provider misinformation. July 18 2025. Accessed September 26 2025. https:\/\/dhhs.ne.gov\/Pages\/DHHS-Gives-Update-on-Medicaid-Rate-Adjustments-Sets-Record-Straight-on-Misinformation.aspx"},{"key":"e_1_3_2_14_2","unstructured":"kffmariap A profile of Medicare-Medicaid enrollees (dual eligibles). KFF. January 31 2023. Accessed December 19 2025. https:\/\/www.kff.org\/medicare\/a-profile-of-medicare-medicaid-enrollees-dual-eligibles\/"},{"key":"e_1_3_2_15_2","unstructured":"MGMA. Medical practice operating costs are still rising in 2025 \u2014 here\u2019s how to control them. March 28 2024. Accessed September 25 2025. https:\/\/www.mgma.com\/mgma-stat\/medical-practice-operating-costs-are-still-rising-in-2025-heres-how-to-control-them"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/24741264241288655"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2021.02.003"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2023.06.021"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000000468"},{"key":"e_1_3_2_20_2","unstructured":"Congressional Budget Office. Estimated Budgetary Effects of Public Law 119-21 to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14 Relative to CBO\u2019s January 2025 Baseline. July 21 2025. Accessed December 13 2025. https:\/\/www.cbo.gov\/publication\/61570"}],"container-title":["Journal of VitreoRetinal Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24741264261440803","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/24741264261440803","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24741264261440803","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:24:44Z","timestamp":1790695484000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/24741264261440803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":19,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/24741264261440803"],"URL":"https:\/\/doi.org\/10.1177\/24741264261440803","relation":{},"ISSN":["2474-1264","2474-1272"],"issn-type":[{"value":"2474-1264","type":"print"},{"value":"2474-1272","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]}}}