■ The proposed CY 2022 Medicare Physician Fee Schedule for MIGS procedures has drawn fire from the makers of MIGS devices because it recommends only an incremental $35 payment for implanting an aqueous drainage device (ADD) in combination with cataract surgery. During calendar year 2021, the median Medicare physician reimbursement for 0191T was about $350, so the proposal represents a 90% cut. Following its survey of surgeons, the RVS Update Committee of the American Medical Association recommended an incremental $95, which CMS did not accept. Glaukos, a leader in MIGS, was among the first to speak out against the proposed fee and said the company would use the 60-day comment period to marshal support for an upward revision in the final Physician Fee Schedule, which will be announced in November.

“We are aware of and extremely disappointed with CMS’ proposed 2022 physician fees for the new Category I codes that cover our sight-saving trabecular microbypass technologies used in combination with cataract surgery,” said Thomas Burns, Glaukos president and CEO, in a news release. “While this is unwelcomed and unexpected news that we believe is unjustified, we are eager to engage with our key ophthalmic societies and are committed to exploring every option during the public comment period in hopes that medical providers across our network are paid appropriately for conducting these types of procedures.”

Ophthalmic coding expert Kevin J. Corcoran, president of Corcoran Consulting Group, called the proposed fee problematic.

“These are not final numbers, and CMS’ proposal is likely to change in Q4,” he said. “The CMS proposal, if taken at face value, assigns an extremely low value to the implantation of an iStent (Glaukos) or Hydrus (Ivantis). The difference between cataract surgery with a stent and without a stent is $35. In comparison, a subconjunctival injection (68200) pays $42. This would suggest that a major intraocular surgery is worth less than a minor procedure such as an injection — an unreasonable answer.”

The proposed rule and accompanying addenda include payment rates for 2 new Category I CPT codes: 669X2 for noncomplex cataract extraction in combination with the insertion of an aqueous drainage device and 669X1 for complex cataract extraction in combination with the insertion of an aqueous drainage device. Category I CPT codes 669X2 and 669X1 will replace Category III code 0191T that physicians used to seek reimbursement. Additionally, +0376T, which is used to report a second ADD implant in the same operative session, will be discontinued on January 1, 2022, and there is no replacement CPT code.