Glaucoma Surgery Shifts Among Medicare Beneficiaries After 2022 Reimbursement Changes in the United States

Abstract

Purpose: To analyze utilization rates of glaucoma surgeries and MIGS among United States Medicare beneficiaries between 2021–2022. Design: Retrospective comparative analysis of 68,118 unique patients. Methods: National claims data from a 5% sample of all Medicare beneficiaries were utilized to compare glaucoma procedure counts between the first quarter of 2021 and the first quarter of 2022. Duplicate claims were excluded, and 50 modifiers were counted as two distinct procedures. A multiplier was applied to estimate annual utilization for the entire Medicare population. Chi-square analysis was employed to compare categorical data from the two time periods. Results: Current Procedural Terminology (CPT) codes for angle-based stenting decreased by an estimated 20,960 procedures between 2021 and 2022 (28.60%). Goniotomy increased by an estimated 11,680 procedures (66.97%) and canaloplasty increased by an estimated 6,640 procedures (47.43%). Glaucoma surgeries decreased by an estimated 5,760 procedures (4.25%) despite an increase of cataract surgery by 234,960 procedures (15.63%), an increase in YAG capsulotomy by 19,280 procedures (3.31%), and an increase in intravitreal injections by 146,320 procedures (3.86%). Conclusion: This study revealed best-estimated surgical procedural counts for 2021 and 2022 and suggests a direct influence of coding and reimbursement changes on surgical device selection. Despite overall surgical volume increases among the ophthalmology procedures, angle-based stenting utilization decreased significantly with an accompanying trend change following the coding and reimbursement changes implemented in January of 2022. Of the MIGS procedures, goniotomy and canaloplasty counts increased the most between these periods. Trabeculectomy and glaucoma drainage device procedures continued to decrease, following well-established trends. Future studies are warranted to examine how these shifts in utilization may impact patient care outcomes.