Over the past year, the Ophthalmic Outpatient Surgery Society (OOSS) has worked closely with the American Academy of Ophthalmology (AAO), ASCRS, and the American Glaucoma Society (AGS) to ensure that Medicare Administrative Contractors (MACs) establish reasonable and appropriate local coverage determinations (LCDs) for micro-invasive glaucoma surgery (MIGS) procedures. As a result of these efforts, in December 2023, the MACs withdrew a proposed LCD that was troublesome for many reasons.
This week, Noridian, WPS, NGS, CGS, and Palmetto posted identical revisions to their MIGS payment policies. We are pleased that many of the ophthalmology community’s comments have been addressed.
These MACs are conducting open meetings to garner comments from medical organizations and industry representatives on the proposed LCD changes. At the Palmetto open meeting, AAO, ASCRS, AGS, and OOSS made a joint presentation applauding the carriers for making significant changes in its policies that for the most part reflect current best medical practices.
Our summary comments:
- Patients with glaucoma, a disease which disproportionately affects Black and Hispanic patients, need access to a range of surgical procedures.
- For many patients, treatment with medications is inadequate, yet their glaucoma does not require more invasive procedures such as trabeculectomy and tube shunts. For these patients, MIGS help preserve quality of life, reduce treatment burden, and reduce total costs to the healthcare system.
- We support further studies to investigate the indications of combining phacoemulsification/intraocular lens placement with more than one MIGS procedure (e.g., cataract + stent + canaloplasty or goniotomy). We ask that carriers expand coverage when more outcome data are available.
The Medicare contractors are soliciting comments on this issue through July 14. We are grateful to the AAO’s leadership and staff for its efforts in coordinating the ophthalmology community’s remarks on this important issue. OASC
