Approximately 3 million Americans have glaucoma. Because the disease often progresses silently in the initial stages, with no symptoms, it is estimated that up to half of the approximately 3 million Americans with the disease don’t know they have it. Vision loss from glaucoma is permanent and irreversible. While anyone can get glaucoma, certain groups of people are at higher risk for the disease. Glaucoma is more likely to occur in African Americans than in Caucasians and is a leading cause of blindness among African American and Hispanic populations in the United States. People with diabetes are nearly twice as likely to develop glaucoma as adults without diabetes. And people with a family history of glaucoma are more likely to get glaucoma too. Although glaucoma cannot be cured, early detection and treatment usually can stop further damage and prevent blindness. The benefit provided by Medicare offers a comprehensive glaucoma screening for seniors and others with Medicare at high risk for the disease.

Medicare Coverage

Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high risk groups:

• Individuals with diabetes mellitus
• Individuals with a family history of glaucoma
• African-Americans age 50 and older
• Hispanic-Americans age 65 and older

A covered glaucoma screening includes:

• A dilated eye examination with an intraocular pressure (IOP) measurement; and
• A direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination

What Can You Do?

Your high risk Medicare patients may not remember to schedule their annual glaucoma screening exam. You can help remind them by talking with them about glaucoma and their risk for the disease, what can happen when glaucoma goes undetected/untreated, and how they can help protect themselves from severe consequences with early detection by getting an annual glaucoma screening exam. Your reminder and referral for a glaucoma screening exam can help provide high risk Medicare beneficiaries with peace of mind and safeguard their vision.

For More Information

CMS offers a variety of educational products and resources to help health care professionals and their staff learn more about coverage, coding, billing, and reimbursement for preventive services and screenings covered by Medicare:

• The MLN Preventive Services Educational Products Web Page ~ provides educational products related to preventive services.
• Glaucoma Screening Brochure - This tri-fold brochure provides health care professionals with an overview of Medicare’s coverage of glaucoma screening services. Download PDF file here or Order copies of the brochure.
• Find more information on preventive services covered by Medicare on the CMS website.  Select “Medicare”, and scroll down to the “Prevention” section. 
• For information to share with your Medicare patients, visit www.medicare.gov
• For more information about glaucoma, visit The National Eye Institute  
• For more information about National Glaucoma Awareness Month, please visit Prevent Blindness