Medicare reimbursement rates for glaucoma procedures have been steadily declining

Investigators studied 20-year trends in Medicare reimbursement rates for common glaucoma procedures.

Study design

Reimbursement data for CPT codes for 22 glaucoma procedures (e.g., goniotomy, aqueous shunt, iridectomy, trabeculoplasty), for the years 2000–2020, were compiled from the US Centers for Medicare and Medicaid Services (CMS) physician fee schedule database. Compensation trends were investigated after data were adjusted for inflation to 2020 US dollars.

Outcomes

Between 2000 and 2020, the average adjusted reimbursement for the 22 analyzed procedures decreased by 20.5%. The greatest reductions in reimbursement rates were seen for laser trabeculoplasty (48.9%), laser iridotomy (37.0%), and cyclophotocoagulation (32.4%). The only CPT code with greater reimbursement rates over the 20-year time period was the one for iridoplasty–photocoagulation, with an increase of 1.9%.

Limitations

The authors did not note any limitations regarding their study methodology or results, which were relatively straightforward. However, the volume of procedures performed and time spent per procedure were not analyzed in this study; this information may be relevant in the reasoning behind reimbursement cuts.

Clinical significance

Ophthalmologists, and glaucoma specialists in particular, care for a large proportion of Medicare patients and are therefore especially vulnerable to decreases in Medicare reimbursements. If Medicare reimbursement trends continue to fail to match the rate of inflation, unintended consequences for patients may result. Decreasing Medicare payments for glaucoma procedures may lead fewer ophthalmology residents to pursue glaucoma fellowships and thus reduce access to subspecialty care for our aging population. Increasing pressure on CMS and Congress by physician groups has the potential to mitigate further reimbursement cuts.