Trends in Medicare Reimbursement and Service Volume of Vitreoretinal Procedures: 2000 to 2021

<b>Purpose:</b> To characterize trends in service volume and inflation-adjusted Medicare reimbursement of vitreoretinal procedures over the past 2 decades. <b>Methods:</b> Medicare Part B National Summary Data Files were accessed to identify the number of allowed services for vitreoretinal procedures. The Medicare Physician Fee Schedule was accessed to identify average annual national reimbursement rates. The Spearman correlation coefficient was used to evaluate time trends for each procedure. All analyses were conducted using Prism 9.5.1 software with 2-sided significance testing and statistical significance set at <i>P</i> ≤ .05. <b>Results:</b> From 2000 to 2021, the 2-tailed Spearman correlation showed that 20 of 38 procedures had statistically significant decreases in service volume over time. Intravitreal injections increased more than 1000-fold, from 2922 in 2000 to 3 444 500 injections in 2021 (ρ = 0.997; <i>P</i> < .001). Panretinal photocoagulation treatments declined from 104 865 to 48 533 procedures (ρ = -0.966; <i>P</i> = .003). Scleral buckling declined from 6502 to 587 procedures (ρ = -0.999; <i>P</i> < .001). Pars plana vitrectomy-associated procedures increased from 71 039 to 95 429 (ρ = 0.691; <i>P</i> < .001). From 2000 to 2021, the 2-tailed Spearman correlation showed that 29 of 38 procedures had statistically significant decreases in reimbursement over time. No procedure had a significant increase in payment. <b>Conclusions:</b> Vitreoretinal practice patterns have changed dramatically over the past 2 decades, with significant declines in inflation-adjusted Medicare reimbursement for most procedures. Awareness of service volume and reimbursement trends is vital to assessing economic viability and patient coverage under the current Medicare payment policies.