Revisiting Medicaid Reimbursements and Their Effects on the Economics of Pediatric Ophthalmology Two Years Later.

Abstract

Purpose: To identify changes in Medicaid reimbursement rates for new patient and follow-up visit billing codes for pediatric ophthalmologists between the years 2022 and 2024.

Methods: Individual state Medicaid sites and state ophthalmology associations were used to determine Medicaid reimbursement rates for new patient and follow-up billing codes. The percentage change between 2022 and 2024 for these billing codes was calculated and comparisons were made for each individual state.

Results: Forty-six states, including the District of Columbia, were used to make comparisons between 2022 and 2024 Medicaid reimbursement rates for new patient and follow-up visits. The average change between 2022 and 2024 was +3.81% for the new patient visit and +4.98% for the follow-up visit. Twenty-one states had increases in reimbursement rates from 2022 to 2024, and eight had decreased rates. Pennsylvania, Illinois, Indiana, Hawaii, and New Mexico demonstrated the greatest increases in new patient visit reimbursement rates. Alaska, Pennsylvania, Illinois, Indiana, and Hawaii had the greatest increases for follow-up visit reimbursement rates.

Conclusions: Raising Medicaid reimbursement rates can alleviate the economic and workplace issues pediatric ophthalmologists face. State level advocacy is important in increasing Medicaid reimbursement rates effectively. [J Pediatr Ophthalmol Strabismus. 2025;62(3):160-165.].