Monday, December 6, 2021

Medicare Trivia: Why Is Medicare Glaucoma Screening Only 50-100 Cases Per Year?

I got an interesting email this week from a graduate student in health policy working on Medicare preventive benefits.  He was asking, "Why is the Medicare usage of glaucoma screening so low?  Only 50-100 cases per year?"


The glaucoma screening benefit was created by legislation in 2000 (BIPA 2000).  (See Foote & Blewett, footnote.)   It's memorialized at 42 CFR 410.23.   It's a subpopulation-guided preventive benefit, for Medicare beneficiaries who have diabetes, a family history of glaucoma, or are African-Americans or Hispanic-Americans.  Using recent data files for annual Part B payment volumes, usage was about #100 cases in 2019, and about #50 cases in 2020 (Covid year).

The codes are G0117, G0118:

• G0117 (Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist)

• G0118 (Glaucoma screening for high-risk patients furnished under the direct supervision of an optometrist or ophthalmologist).


See a JAMA article this month on Medicare & Prevention & Health Equity, Niforatos et al. here.

I'm not sure how many cases I expected - 1,000?  10,000?  Other?  But not #50.   If anyone has a clue, let me know.

Someone suggested to me that most patients eligible for this benefit also have other reasons for seeing an optometrist or ophthalmologist that result in a covered office visit rather than a unique code for a stand-alone glaucoma screening test and no other service that day.  Generally, office visits aren't very tightly edited for ICD10 codes since office visits can be associated with any human disorder or condition.

For more on the glaucoma benefit:

See a standalone version of the glaucoma screening act, 2000, here.

See a coding reference site about the benefit here.  Hispanics were added in 2006.

See a 2002 ophthalmology trade journal here and a 2002 optometry trade journal here.


Foote & Blewett, 2003.  Politics of prevention: expanding prevention benefits in the Medicare program. J Public Health Policy, .

click to enlarge

Foote and Blewett, 2003, Politics of Prevention: (Benefits in Medicare).