Coding & Reimbursement

Reading the glaucoma reimbursement tea leaves

Studying recent Medicare payment trends points to where treatment is headed.

By Suzanne L. Corcoran

This month we will review trends in glaucoma reimbursement — past and future — in the larger context of eye care.

In the United States, the most common eye diseases are age-related macular degeneration, cataract, glaucoma and diabetic retinopathy. As baby boomers age, their demands for healthcare and eye care will grow. Some ocular conditions consume more Medicare dollars than others: Retina procedure volume is growing most rapidly; cataract surgery grows at the same rate as the Medicare population; glaucoma procedure volume is almost unchanged.

Q. Put this into context: How big is the Medicare payment pie for eye care?

A. Table 1 shows Medicare Part B payments to ophthalmology and optometry in 2014 (the most recent data available). Altogether, Medicare paid $9.52 billion for eye care. While this is a relatively small portion (1.5%) of all Medicare payments of $618.7 billion, it is growing.

Q. What were the most frequent surgical procedures paid to ophthalmology?

A. Of all surgical procedures Medicare Part B paid to ophthalmology in 2014 (specialty 18), Table 2 shows the top 10. Two of these were laser procedures for glaucoma.

Besides laser procedures, filtration procedures and aqueous drainage devices constituted the three segments of all glaucoma procedures:

• Lasers

◦ Laser trabeculoplasty (65855)

◦ Iridotomy (66761), iridoplasty (66762)

• Filtration

◦ Trabeculectomy (66170, 66172)

• Aqueous drainage device

◦ Tube (66180)

◦ External approach (66183)

◦ Internal approach (0191T)

Q. What has happened to utilization of glaucoma surgical procedures within the Medicare program?

A. In 2014, trabeculoplasty and iridotomy constituted more than 60% of all glaucoma procedures performed on Medicare beneficiaries — a total of 371,000 procedures. Other procedures are much less frequent (Table 3).

Over a 20-year period, 1994-2014, the volume of all glaucoma surgery within Medicare Part B has remained fairly constant while the number of beneficiaries has grown (Figure 1). Laser trabeculoplasty (LTP) declined steadily from 1994 to 2001 and then increased sharply with the introduction of selective laser trabeculoplasty (SLT). Trabeculectomy (Trab) has steadily declined while tube shunts, cyclophotocoagulation (CP) and minimally invasive glaucoma surgery (MIGS) have gained. Laser peripheral iridotomy (LPI) is flat.

Figure 1. Glaucoma surgery utilization
Source: Medicare Part B paid claims data 1994-2014

This data omits Medicare Part C (Medicare Advantage), beneficiaries, who make up about 30% of all Medicare beneficiaries.

Looking ahead, sustainable drug delivery of antiglaucoma medications implanted within the anterior chamber holds great promise to transform the treatment of glaucoma. As with anti-VEGF agents for the treatment of exudative AMD, injectable medications for glaucoma could add millions of surgical procedures per annum. In comparison, the other segments (such as lasers, filtration, shunts) would be relatively small. OM

Suzanne L. Corcoran is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com.