Comparing Utilization of Operative versus Awake Laryngoplasty Techniques in the United States Medicare Population:...

Injection laryngoplasty (IL) is performed to correct glottic insufficiency. There has been a purported shift away from operative techniques in favor of awake, in-office procedures, but no studies comparing utilization include updated current procedural terminology (CPT) coding. We analyzed the usage of operative versus awake injections CPT codes over 2 decades, recognizing that these encompass a broad array of injection procedures.

Retrospective database study.

United States Medicare Population from 2001 to 2022.

Utilization and reimbursement data compiled by the US Centers for Medicare & Medicaid Services were queried for CPT codes encompassing awake injections (31513, 31573, 31574), operative ILs (31570, 31571), and operative medialization laryngoplasties (31588, 31591).

10,186 injections were performed in 2022, a 195% increase from 2001. Awake injections grew by 412.77%, while operative injections grew by 134.75%. Operative injections are still more common (79.4% in 2001; 64.24% in 2022) and population-adjusted use of 31571 grew between 2001 and 2021, while 31570 decreased. Since its adoption in 2017, awake IL code 31574 increased by 66.6%. From 2001 to 2006, the annual growth rate of awake injections was significantly lower than that of operative IL (P < .0001). From 2017 onwards, the awake IL growth rate was significantly higher than operative injections (P = .020).

Awake injection utilization increased over the 22-year period, as introduction of code 31574 coincided with a relative decline in operative and an increase in awake IL. Otolaryngologists may be implementing awake injections due to reduced recovery time and introduction of more specific CPT codes.