Substantial Fee Cuts Looming for Glaucoma Procedures

Ophthalmologists should expect substantial cuts related to glaucoma surgery in Medicare’s 2016 fee schedule. The three procedures on the chopping block could be slashed by double-digit percentage points. The Academy and the American Glaucoma Society sought to ensure fairness through a vigorous defense last year before the American Medical Association’s Relative Value-Scale Update Committee. Unfortunately, the Academy believes CMS will give higher priority to recent improvements to physician efficiency and surgical times. The cuts are part of a congressional mandate to CMS to identify $1 billion in misvalued codes annually for the next three years.

Affected codes

The change would affect these glaucoma trabeculectomy codes:

• 65855 (trabeculoplasty by laser surgery);
• 66170 (trabeculectomy ab externo in absence of previous surgery);
• 66172 (trabeculectomy ab externo with scarring from previous ocular surgery or trauma).

All three codes were surveyed by the Academy in partnership with the glaucoma society. CMS targeted these codes based on the high level of post-operative visits built into the existing payments. In defending them, we outlined for the RUC how these frequent postoperative visits help ensure surgical success.

In the case of trabeculectomy surgeries, member surveys showed these procedures take less time to do than they used to. The new fees are expected to reflect that.

CMS’ final decision on whether the code values are too high and the severity of the cuts won’t be known until the fee schedule is released before the end of October.