Clinical Report: The Growth Rate of MIGS Within Part B Medicare
Overview
The report highlights the significant growth of micro-invasive glaucoma surgery (MIGS) procedures within Part B Medicare, particularly following the FDA approval of iStent in 2012. However, recent regulatory changes, such as the proposed local coverage determination (LCD) in 2023, may slow this growth despite ongoing demand for MIGS.
Background
Understanding the trends in MIGS is crucial as glaucoma remains a leading cause of blindness, and effective management is essential for patient outcomes. The increasing enrollment in Medicare Advantage and the evolving landscape of glaucoma treatment underscore the importance of monitoring MIGS utilization and coverage policies. Regulatory changes can significantly impact the availability and adoption of these innovative surgical options.
Data Highlights
| Year | Number of Procedures |
|---|---|
| 1994 | 361,358 |
| 2001 | 208,848 |
| 2019 | Over 100,000 |
| 2020 | Estimated 50,000 (due to COVID-19) |
Key Findings
- The annual average number of glaucoma procedures from 1994 to 2023 was 307,878.
- MIGS procedures surged after the FDA approval of iStent in 2012.
- A proposed local coverage determination (LCD) in 2023 may reduce the growth rate of MIGS procedures.
- Technologies like direct selective laser trabeculoplasty (DSLT) and multifocal pupillographic objective perimetry (mfPOP) are emerging to support glaucoma management.
- Optical coherence tomography angiography (OCTA) is likely to see increased utilization for assessing ocular blood flow in glaucoma patients.
Clinical Implications
Healthcare providers should be aware of the changing landscape of MIGS coverage and the potential impact on patient access to these procedures. Emphasizing alternative treatments such as DSLT and mfPOP may be necessary to maintain effective glaucoma management as regulatory constraints evolve.
Conclusion
The growth of MIGS within Medicare is significant, but recent policy changes may necessitate adjustments in clinical practice and patient management strategies. Ongoing innovation in glaucoma treatment technologies, such as DSLT and OCTA, will remain essential to meet patient needs.
References
- Corcoran K.J., Glaucoma Physician, 2024 -- Coding: Medicare Coverage of MIGS
- Corcoran K.J., Ophthalmology Management, 2025 -- Coding & Reimbursement: Navigating New Coverage Challenges for MIGS
- Corcoran K.J., Ophthalmology Management, 2017 -- Coding for Minimally Invasive Glaucoma Surgery
- Corcoran K.J., Glaucoma Physician, 2020 -- Coding: MIGS Approved Implants and Compliance
- American Academy of Ophthalmology, PubMed, 2026 -- Primary Open-Angle Glaucoma Preferred Practice Pattern®
- Bhim Bahadur Rai, MD, et al., PubMed -- Five-year outcomes of a Schlemm's canal microstent (Hydrus Microstent) with cataract surgery in open angle glaucoma: real-world results
- IRIS Registry Study, ScienceDirect, 2026 -- Outcomes of Minimally Invasive and Traditional Incisional Glaucoma Surgery
- Primary Open-Angle Glaucoma Preferred Practice Pattern® - PubMed
- Five-year outcomes of a Schlemm's canal microstent (Hydrus Microstent) with cataract surgery in open angle glaucoma: real-world results - PubMed
- Outcomes of Minimally Invasive and Traditional Incisional Glaucoma Surgery: An IRIS® (Intelligent Research in Sight) Registry Study - ScienceDirect
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