Cataract Surgery Billing Reform ($26 Million in Annual Spending)

Summary

Cataract surgery is one of the most common medical procedures performed in British Columbia. Due to advances in surgical techniques and equipment, the procedure can now be completed significantly faster than when current Medical Services Plan (MSP) reimbursement rates were established.

Despite these improvements, reimbursement rates for cataract surgery have not been updated to reflect reduced procedure times. As a result, ophthalmologists now account for a disproportionate share of the highest MSP billings in the province.

According to ministry data, cataract surgeries cost British Columbia approximately $26 million per year on average.

Problem

Cataract surgery falls under MSP billing codes S02188 and S02190, which allow ophthalmologists to bill the province $372.20 per procedure.

Modern cataract surgery can now be completed in approximately 10 to 20 minutes, allowing significantly more procedures to be performed in a single day than when the current billing structure was established.

Data provided by the Ministry of Health shows that usage of these billing codes increased from approximately 66,000 procedures in 2020 to 83,000 procedures in 2025, creating growing cost pressure on the healthcare system.

Analysis of the BC MSP Blue Book also shows that ophthalmologists dominate the highest physician billings in the province. Of the top ten highest-billing practitioners in the 2023–2024 fiscal year, nine were ophthalmologists, and more than 40 percent of the top 200 highest billers were in the field.

While ophthalmologists provide important care, the current reimbursement structure appears to reflect outdated assumptions about the time and intensity required to perform cataract surgery.

Solution

Reduce the cataract surgery reimbursement rate by 10% per year for three years in a row.

The province could renegotiate the MSP reimbursement rate for cataract surgery to reflect the shorter time required to perform the procedure today. Advances in technology have significantly reduced surgery time, but the billing code has not been updated. Adjusting the reimbursement rate would reduce costs while maintaining access to care.

Current rate: $372.20

Year 1: $334.98

Year 2: $301.48

Year 3: $271.33

Fiscal Impact

Savings per procedure once fully implemented: $100.87

$100.87 in savings per procedure × 83,000 procedures = $8,372,210

Total Savings: $8,372,210 annually once fully implemented