Cash-Pay Ophthalmology Services: A Guide to Higher Margins for Your Practice

It’s not just you: operating margins across the ophthalmology industry are rapidly narrowing. In an effort to exert greater control over their margins, eye care practices are increasingly turning to cash-pay ophthalmology services.

Margins are under pressure from a combination of falling reimbursements and rising costs. Medicare reimbursements have fallen year-over-year every year since the pandemic, with ophthalmic surgeons facing a rate cut of nearly 3% in 2025. That’s on top of a 3.4% drop in the Medicare Physician Fee Schedule conversion factor the year before.

For an example of what this looks like in a typical ophthalmology practice, let’s look at cataract surgery. Between 2018 and 2025, reimbursement for complex surgery (CPT 66982) dropped by more than 12%, and reimbursement for simple surgery (CPT 66984) dropped by more than 20%.

At the same time practices are seeing less money coming in from reimbursements, more money is going out in the form of expenses. Operating costs in the average medical group, regardless of specialty, are up more than 11% year-over-year, driven by rising costs of staffing and medical supplies.

The cash-pay model in ophthalmology is one way to escape the squeeze. Under this model, practices are not at the mercy of payer reimbursement schedules. With insurers out of the picture, some practices report that they are able to be more patient focused. And since billing patients directly is simpler than insurance billing, billing workflows can be more efficient.

That said, cash pay is not without its downfalls. The best option for many practices may be a hybrid model, combining cash-pay services with insurance billing.

Jump To:

Ophthalmology’s Greatest Opportunity: The Insurance-Private Pay Hybrid Model

The Downsides to a Single Payment Model

Ophthalmology Procedures With a High Cash-Pay ROI

Profitable Ophthalmology Procedures With High Demand

Your Step-by-Step Guide to Introducing Cash-Pay Ophthalmology Services

The Ophthalmologist’s Cash-Pay Services Checklist

Adding Cash-Pay Services Can Strengthen Your Ophthalmology Practice’s Margins

Ophthalmology’s Greatest Opportunity: The Insurance-Private Pay Hybrid Model

First, let’s talk about why now is the perfect time to try cash pay.

The rate of eye conditions like cataracts and AMD rises as a population ages, and the Baby Boomers are reaching later life. The U.S. Census Bureau estimates the number of Americans 65 and older will rise by 31% between 2022 and 2035. By 2030, the Bureau projects one in five Americans will be over 65.

Treatment for age-related eye conditions is usually covered by insurance, but upgrades and enhancements are not. Many members of the Baby Boomer generation have disposable income they’re willing to spend to support their active lifestyles.

By combining insurance with out-of-pocket payments, you can bill insurance for the necessary surgery, then patients can opt to add on procedures that will add to their quality of life, like LASIK or advanced intraocular lenses.

A hybrid model makes these private-pay procedures more appealing, because patients aren’t having to budget for either the surgery they need or the surgery they want.

For example, let’s imagine a cataract patient whose insurance covers the cataract removal. The ophthalmologist can then suggest multifocal intraocular lenses that will free the patient from their collection of different glasses for different activities.

To the patient, who is undergoing surgery either way, this upgrade feels easy. They will come out of surgery with overall improved vision, which is what they really want, while paying for just one procedure rather than two.

A growing number of ophthalmic surgeons are also offering traditionally aesthetic treatments, like blepharoplasty. This offers patients a convenient option for improving their appearance with a medical practice they already know and trust.

The Downsides to a Single Payment Model in Ophthalmology

Just as an all-insurance payment model has a downside—putting you at the mercy of payer schedules—so does an all-cash-pay model.

In an economic downturn, people tend to cut back on medical care they deem unnecessary—including routine preventative care. Patients are willing to pay out-of-pocket for premium services, but often balk at paying for regular office visits, dropping your patient volume and revenue.

Cash-pay practices also don’t get insurance referrals, so they need to invest more in marketing. And some patients may feel suspicious of a practice not affiliated with any kind of insurance.

By continuing to work with insurers, and adding cash-pay services, you get the best of both worlds. You get paid regularly for routine office visits, you get insurance referrals, and your patients get the routine checkups they need. At the same time, cash-pay premium services add a new, lucrative revenue stream.

Simplify billing, even among multiple payers, with smart, automated billing tools designed for ophthalmology practices. Schedule a Demo.

Cash-Pay Ophthalmology Services With a High ROI

When introducing cash-pay services in your ophthalmology practice, focus on procedures that have both high demand and high profitability.

Profitable Ophthalmology Procedures With High Demand

• Premium intraocular lenses paired with cataract surgery
• LASIK
• Aesthetic procedures, including blepharoplasty and Botox injections
• Advanced diagnostics not covered by insurance, such as early-detection glaucoma screening

When choosing procedures to offer, consider these factors to maximize your profitability:

• Equipment investment. Focus first on procedures that use equipment your practice already has. If you decide to buy new equipment, choose tools with multiple uses and a high ROI.
• Clinical staffing. Be sure you have enough clinicians on staff with the skills and experience needed to perform the procedure. Marketing a procedure will create demand; you need to have the capacity to meet it.
• Competitive landscape. Review the offerings of other ophthalmology practices in your area. Rather than following the crowd, look for service gaps in high-demand procedures like Botox and blepharoplasty.

Your Step-by-Step Guide to Introducing Cash-Pay Ophthalmology Services

Step 1: Forecast ROI of Private-Pay Procedures

Before making any changes to your practice’s service offerings, forecast the potential ROI. Choose a procedure to consider, then research it to make a business decision rooted in data, not gut feelings.

Start your research with the data in your ophthalmology practice management system. Nextech’s platform makes it easy to filter patients by age, diagnosis, and past treatment to identify how many people in your current patient pool could benefit from the procedure you’re considering.

For example, if you’re researching premium IOLs, see how much of your existing patient pool is over 60 and scheduled for surgery to treat early-stage cataracts.

Next, estimate the uptake rate. Start with industry benchmarks—for example, premium IOL adoption rates range from 10 to 25%—then adjust for the demographics in your market. Use conservative numbers to start.

Finally, calculate the per-treatment profit. Estimate the cost of offering the procedure, such as supplies, staff time, and marketing. Subtract that from the price you could reasonably charge.

When setting a price, you want it high enough to deliver a comfortable profit, but not so high it discourages people from buying. Research how competitors price similar services, and explore how you can bundle services like consultation and follow-up care for a higher perceived value.

To reach your ROI forecast, multiply the number of eligible patients by the uptake rate by the per-treatment profit.

For example, 200 cataract patients per year x 15% expected uptake x $1,800 profit per treatment = $54,000 projected profit.

Make better business decisions by getting valuable patient data in easy-to-understand dashboards and reports. Schedule a demo of Nextech's technology platform for ophthalmology.

Step 2: Ensure You Can Meet Demand

Once you’ve decided on a new offer and how to price it, get your eye care practice ready to deliver. Educate your staff on the new service and give them talking points to upsell patients. Patient conversations need to shift from a position of “what’s covered” to a position of “what’s possible.”

Document workflows for the new procedure, from consultation to scheduling to procedure to payment to follow-up. Be sure everyone understands their role: schedulers need to know how elective procedures will impact the schedule, billers need to know how to handle cash-pay billing, etc.

Step 3: Double-Check Compliance

Depending on the service and on your state, there may be legal and regulatory considerations for how cash-pay services are marketed, delivered, and billed.

Check state-level regulations on elective ophthalmology procedures such as LASIK and premium IOLs, and familiarize yourself with any rules around cash-pay offers. Nextech keeps practices compliant by centralizing documentation, consent forms, and billing information in a single, ophthalmology-specific platform.

Even if your state has no regulations around cash-pay services for now, stay on the right side of ethics by acting as though it does. Be transparent in your pricing and obtain informed consent before putting a patient on the schedule.

Step 4: Market Your New Cash-Pay Ophthalmology Service

With the back end in order, you’re ready to introduce your new cash-pay ophthalmology service to the public. Remember that you won’t get insurance referrals for a cash-pay service, so you need to build awareness through other channels.

Here are a few ideas for promoting your new service:

• Place visible promotional materials like signage and brochures in conspicuous spots inside your practice, so current patients see them when they come in for an appointment.
• Develop digital campaigns such as website landing pages, digital ads, and social media campaigns. Nextech’s built-in marketing tools enable you to segment your audience and trigger automated outreach so the right people get the right message at the right time.
• Launch an outreach campaign to past and existing patients using direct mail and email. Create an ongoing email campaign that is triggered to automatically reach out to eligible patients as they enter the system.
• Build a referral network with area opticians who may identify patients in need of surgical care.

Establish a mechanism for tracking patient interest as you roll out your new service. Measure things like how many conversations are had in-office, how many visits to a landing page, and how many people request information.

Grow your practice with a HIPAA-compliant CRM built right into our ophthalmology-specific technology platform. Schedule a Demo.

Step 5: Use Technology to Maximize Success

To get the best results from your new cash-pay service, use Nextech’s integrated ophthalmology technology platform to track results and continually improve.

• Track patient outcomes in the EHR. This is valuable data to help you deliver better service and to improve future marketing campaigns.
• Streamline billing with a built-in payment solution. Eliminate any friction at the point of payment. Offer patients convenient options to pay online, pay at the time of service, or sign up for a payment plan.
• Track ROI. Nextech’s healthcare CRM enables you to track the ROI of your marketing campaigns, so every dollar is well spent. You can also track the ROI of the service itself to see if it’s meeting your expectations.
• Review data in easy-to-read reports and dashboards to identify areas for improvement.

The Ophthalmologist’s Cash-Pay Services Checklist

• Identify potential cash-pay service offerings
• Develop a pricing strategy for cash-pay procedures
• Forecast ROI
• Create workflows for delivering cash-pay services
• Educate staff on the new service
• Double-check regulatory compliance
• Launch marketing campaigns
• Track patient interest
• Measure outcomes and optimize over time

Adding Cash-Pay Services Can Strengthen Your Ophthalmology Practice’s Margins

Your ophthalmology practice doesn’t have to choose between shrinking margins and an all-cash model. A hybrid approach, anchored by insurance and strengthened by premium cash-pay services, offers the best of both worlds.

With careful strategy, this combination can increase revenue, protect profits, and improve patient satisfaction by offering the care patients want—not just what their insurance says they need.

Nextech’s specialty-specific ophthalmology platform makes it easy to create and deliver on that strategy.

See the difference specialty-specific makes. Schedule a demo of Nextech’s technology platform designed just for ophthalmology