Centers for Medicare & Medicaid Services Reimbursement Declines for Chalazion Incision and Drainage

The purpose of this study was to evaluate reimbursement trends for the surgical management of chalazion for the years 2000 to 2023 based on Centers for Medicare & Medicaid Services values.

Reimbursement rates for eyelid abscess blepharotomy and chalazion incision and drainage (Current Procedural Terminology codes 67700 and 67800) were queried from the Physician Fee Schedule Look-Up Tool for the years 2000 to 2023. The average reimbursement, the percent change, and the compound annual growth rate were calculated after adjusting for inflation using the consumer price index. Results were compared with reported reimbursement for other ophthalmic and general procedures.

Reimbursement for facility and nonfacility fees for Current Procedural Terminology code 67700 was $130.84 and $328.41, respectively, in 2023. This corresponded to 9.23% and 11.76% percent changes in facility and nonfacility fees since 2000, adjusted for inflation. Reimbursement for facility and nonfacility fees for Current Procedural Terminology code 67800 was $104.87 and $133.95 in 2023. This corresponded to-20.48% and -57.95% percent changes since 2000, adjusted for inflation. The adjusted compound annual growth rates for code 67700 facility and nonfacility fees were 0.38% and 0.48%. The adjusted compound annual growth rates for code 67800 facility and nonfacility fees were -3.60% and -3.70%.

While both procedure codes have decreased reimbursement over the last decade, code 67700 reimbursement has demonstrated growth above inflation from 2000 to 2023. This observed decrease in reimbursement can be attributed to Medicare budget policy changes in 2013, emphasizing the importance of Medicare reduction limits on the financial stability of certain procedures.