Clinical Scorecard: Coding: The Growth Rate of MIGS Within Part B Medicare

At a Glance

Key Highlights

• MIGS procedures surged after FDA approval of iStent in 2012.
• 2020 saw a dip in procedures due to the COVID-19 pandemic.
• A proposed local coverage determination (LCD) in 2023 may slow MIGS growth.
• Emerging technologies like Voyager DSLT and mfPOP are enhancing glaucoma care.
• Optical coherence tomography angiography (OCTA) is gaining traction for ocular blood flow assessment.

Guideline-Based Recommendations

Diagnosis

• Utilize laser trabeculoplasty, perimetry, and optic nerve imaging to support MIGS recommendations.

Management

• Monitor the necessity of MIGS procedures in light of new LCD policies.

Monitoring & Follow-up

• Increase in laser trabeculoplasty and optic nerve imaging as alternatives to MIGS.

Risks

• Potential reduction in MIGS procedures due to stricter coverage criteria.

Patient & Prescribing Data

Older adults enrolled in Part B Medicare with glaucoma.

MIGS remains a preferred option, but alternative treatments are being emphasized due to regulatory changes.

Clinical Best Practices

• Incorporate new technologies to enhance patient experience and adherence to testing protocols.
• Stay updated on Medicare coverage policies affecting MIGS.

References

• Medicare Advantage overview
• A brief history of MIGS
• Palmetto LCD L37531 micro-invasive glaucoma surgery (MIGS)
• Medicare’s MIGS LCD Finalized
• Alcon innovations on display at AAO 2024
• Transscleral Selective Laser Trabeculoplasty Without a Gonioscopy Lens
• Visual field tests: a narrative review of different perimetric methods
• Evaluating ocular blood flow