Vocal Fold Injection and Thyroplasty Trends From 2012 to 2022 Among Medicare Beneficiaries

To characterize utilization patterns of laryngeal injection procedures (augmentation and therapeutic) and medialization thyroplasty from 2012 to 2022, with particular attention to practice setting, bilateral procedures, and impact of the 2017 Healthcare Common Procedure Coding System (HCPCS) update.

The Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master dataset from 2012 to 2022 was utilized in this analysis. HCPCS codes specific for vocal fold injections (e.g., 31513, 31570, 31571, 31573, 31574) and thyroplasty procedures (e.g., 31588, 31591) were evaluated. The number of procedures performed, place of service, and specialty were recorded.

Total laryngeal procedures increased by 44.7% from 2012 through 2022, including a 52.3% increase in injections and an 11.9% decrease in thyroplasty. Laryngeal injection procedures increased across all practice settings, with a notable trend toward office-based procedures (20% to 28%). In contrast, the proportion of laryngeal injection procedures in the hospital and ambulatory surgical center settings decreased from a height of 70%-60% and 17%-13%, respectively. Bilateral procedures increased by 165%, including a 121% increase in bilateral injection augmentation (code 31574).

Between 2012 and 2022, total laryngeal procedures increased across all practice settings, with a trend toward more injection laryngoplasty, particularly in the office setting. The growth of bilateral procedures, particularly injection augmentation, suggests a growing demand to treat bilateral presbylarynx.