Angle-Based Stent Procedures Declined Coincident With Medicare Reimbursement Cuts

On January 1, 2022, CPT codes for angle-based stenting procedures (Hydrus and iStent) were changed, leading to significant reimbursement cuts for these procedures. This study investigated changes in utilization of glaucoma-related CPT codes before and after this change was implemented.

Study Design

The number of Medicare beneficiaries with carrier-reported CPT codes of interest were compared between the first quarter of 2021 and the first quarter of 2022. Codes were divided into 9 groups by procedure type, including iStent and Hydrus, goniotomy, XEN gel stent and Ex-PRESS shunt, and trabeculectomy. YAG capsulotomy, cataract surgery, and intravitreal injection CPT codes were analyzed as points of reference for comparison.

Outcomes

Angle-based stenting procedures decreased by 29% following coding changes and reimbursement cuts, coinciding with a 67% increase in goniotomies and a 47% increase in canaloplasties. During this time period, there was an overall increase in the total number of ophthalmic procedures performed, likely in part due to recovery from COVID-19 pandemic–related lockdowns. Trabeculectomies and glaucoma drainage device utilization continued to decline, in accordance with a well-established trend.

Limitations

The sample analyzed in the study is representative of the Medicare population and may not represent trends among privately insured and uninsured patients.

Clinical Significance

The data suggest that the nearly 90% cuts to Medicare reimbursements for Hydrus and iStent procedures in 2022 had a major impact on the utilization of these angle-based stents despite their known benefits. This study highlights how reimbursement cuts impact surgical trends and limit patient access to potentially vision-saving care.

Financial Disclosures: Dr. Gillian Treadwell discloses no financial relationships.