Trends in annual medicare expenditures for glaucoma surgical procedures from 1997 to 2006

Objective: To identify payments and changes in payments for glaucoma surgical procedures among Medicare beneficiaries in the United States and to evaluate trends in costs based on the types of procedures being performed. Design: Retrospective analysis using 1997 through 2006 Part B Medicare Beneficiary Encrypted Files. The annual number of claims and payments for glaucoma surgical procedures were calculated, as were the rates per 100 000 beneficiaries. Results: Overall, there were decreases in both the number of glaucoma surgical procedures and the amount of annual payments from 1997 to 2001 but an increase in the number of procedures in the following years. Trends in claims and payments vary according to procedure. Average payments for trabeculectomies decreased over time, while annual payments for cyclophotocoagulation and shunt-related procedures have increased. After an initial decline, there was a substantial increase in the number of trabeculoplasties in conjunction with advancements in technology and a change in the global period for reimbursement. Patterns of surgery rates were similar to volume of surgical procedures. Conclusions: Findings suggest that while the overall number of glaucoma surgical procedures is increasing, payments have been decreasing. Clinical and technological advancements and reimbursement decisions may influence surgeons' preferences and, therefore, costs to Medicare.