SEP 18, 2014
Medicare Reimbursement for Glaucoma Shunt Surgeries Expected to Be Cut in 2015
Glaucoma specialists can expect to see significant cuts in 2015 Medicare payments for glaucoma shunt surgery when performed with a patch graft, due to new codes that bundle the procedures. The Centers for Medicare and Medicaid Services targeted the shunt codes in 2013 as being potentially “misvalued”, and later identified that the patch graft code 67255 was being used along with 66180 more than 70 percent of the time, which then required changes to the family of CPT codes.
The Academy and the American Glaucoma Society surveyed the four new and revised codes for the American Medical Association/Specialty Society Relative Value-Scale Update Committee.
Survey data from the glaucoma community demonstrated that when the shunt or the shunt revision was performed without a graft that the surgical time was fairly represented and in fact the number of postoperative visits was slightly higher. However, when the procedures are performed with the graft, the surveys showed the time to place the graft did not add significantly to the total time for the procedure, and therefore the reimbursement (which is primarily driven by time) will be significantly lower than when the graft was reimbursed as a complete second procedure.
The final rule is expected in early November, at which time CMS will publish whether or not it accepts the RUC recommended values, as well as the values it will use for payment. The new and revised CPT codes for the glaucoma tube shunt to external reservoir family of codes will go into effect Jan. 1, and surgeons will no longer use the additional code 67255 for the patch graft. They are:
- 66179 Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft
- 66180 Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft
- 66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft
- 66185 Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft.