Both cataract and glaucoma are more common with increasing age.  They often coexist together. Currently, many glaucoma patients who undergo cataract surgery have a tiny stent implanted in their eye to improve fluid drainage treating their glaucoma at the same time. The two most commonly used devices for the procedure are the iStent from Glaukos Corporation and the Hydrus from Ivantis, Inc. Medicare currently covers the insertion of both of these devices at the same rate. 

Earlier this summer, Noridian, the contractor that sets the Medicare claims and fee structures for medical procedures, proposed a billing change effective January 1 that could drastically impact the quality of patient treatment and care.

The Importance of Billing Codes

At present, cataract procedures using either of these devices are billed under the same temporary code established by Noridian for “emerging technologies.” If both cataract surgery and the insertion of one of these devices happen simultaneously, two separate billing codes are used. That temporary glaucoma surgery code is set to expire on January 1, 2022, at which time a permanent single code will be assigned for the implantation of these devices during cataract surgery.  

The billing is currently split in two; the actual cataract surgery has a permanent code, and the stent implantation carries the temporary codes. The new, permanent CPT codes (669X1 and 669X2) will combine the surgery and the stent implantation into single billing codes for reimbursement. This would appear to be an efficient move for all concerned.

The Problem with the Proposed New Codes

Unfortunately, the proposed 2022 Medicare Physician Fee Schedule released by the Centers for Medicare & Medicaid Services (CMS) provides for insufficient reimbursement to providers to cover the costs of the combined cataract and glaucoma surgeries. 

The proposed reimbursement for CPT 669X1 would only pay physicians $3 more than the complex cataract surgery rate, and the payment for CPT 669X2 would be only $34 more than cataract surgery alone. These are approximately 1% and 10% of the current reimbursement. Insertion of a stent requires far more time, expertise, and effort than the proposed change acknowledges. 

The American Academy of Ophthalmology (AAO) and the American Glaucoma Society (AGS) strongly oppose the proposed fee schedules and are concerned that the payment rates could negatively impact patients’ access to the minimally invasive microstent glaucoma surgery.

Resistance to New Codes 

The two organizations are calling on CMS to increase its proposed reimbursement rates for CPT codes 669X1 and 669X2, and they urge patients and their families to speak out, as well. You can join the fight for fair glaucoma and cataract reimbursement by using the AAO’s online advocacy tool and making your voice heard. Insufficiently covered costs affect your care.

This article was reviewed and edited for accuracy by Alan Robin, M.D., a Responsum Health Advisory Council member, ophthalmologist, glaucoma treatment specialist, and leader in the clinical management and scientific study of the disease.

*American Academy of Ophthalmology. (2021). Act Today: Stop Intolerable Glaucoma, Cataract Cuts [Press Release].