Undiagnosed patients
Half of people with glaucoma are unaware of it, so a practice that screens routinely will find cases in its own patient base.
CDCGlaucoma Care · Practice Growth
Adding Glaucoma Management Keep high-risk patients in your practice for the long haul.
Glaucoma is a chronic, medically billed condition that brings patients back several times a year for testing and pressure checks. Managing it in-house serves patients who might otherwise wait for a referral slot and builds a steady medical schedule for the practice.
About 3 millionAmericans with glaucoma, per the CDC
50%of people with glaucoma who do not know it
50 stateswhere optometrists may now treat glaucoma
14states that allow optometric laser procedures as of late 2025
Why it fits
A service built on follow-up
Unlike a one-time procedure, glaucoma care is a relationship. Suspects, ocular hypertensives and treated patients all return on a schedule set by risk and stability.
Defined risk groups
Black adults over 40, everyone over 60, people with diabetes and those with a family history are the groups the CDC flags.
CDCMedical billing
Testing and visits bill to medical insurance, and Medicare covers an annual screening for qualifying high-risk patients.
Medicare.govScope of practice
Massachusetts became the last state to allow optometrists to treat glaucoma, completing national authority.
NECOWhat you need to start
The clinical tools are familiar. The difference is a protocol, a recall system and a referral partner for surgery.
- OCT and threshold perimetry
- A written glaucoma protocol
- A surgical co-management partner
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Instruments
OCT with a glaucoma package, a perimeter, a pachymeter, a gonioscopy lens and an accurate tonometer.
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Protocol
Target pressure, test intervals by stage, when to add therapy and when to refer, written down so every doctor manages the same way.
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Recall and adherence
Scheduled testing visits and refill reminders keep patients from drifting out of care between appointments.
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Referral network
An ophthalmologist for laser, MIGS, implants and incisional surgery, with the patient returning to you for ongoing care.
Getting started
Launching the service
Most practices phase it in, starting with patients already in the chart.
Find your suspects
Search the records for elevated pressure, suspicious cupping, family history and diabetes, and invite those patients back for a baseline workup.
Run the baseline
Pressure, pachymetry, OCT, fields and gonioscopy, then a diagnosis and a follow-up interval for each patient.
Manage and co-manage
Treat with drops, refer for laser or surgery when indicated, and keep monitoring the patient in your office afterward.
Reference details
Codes a glaucoma service uses
| 92133 | Optic nerve OCT |
|---|---|
| 92083 | Threshold visual field |
| 92020 | Gonioscopy |
| 76514 | Corneal pachymetry |
| G0117 and G0118 | Medicare glaucoma screening for high-risk beneficiaries |
| H40.1- | Open-angle glaucoma diagnosis codes, which require a stage character |
Medicare screening eligibility
- Diabetes
- Family history of glaucoma
- African American and age 50 or older
- Hispanic and age 65 or older
Scope note
All states now allow optometrists to treat glaucoma, but laser and surgical procedures vary by state; Review of Optometry counted 14 states authorizing optometric laser procedures after West Virginia and Montana passed laws in 2025. Check your state board's rules before adding procedures.
Questions about adding glaucoma care
Is glaucoma care billed to vision plans?
Glaucoma testing and management are medical services billed to the patient's medical insurance, not a routine vision plan.
How do I find patients to start with?
Your own records. Look for elevated pressure readings, suspicious optic nerves, a family history of glaucoma and diabetes, and invite those patients for a baseline workup.
Do I need to own an OCT?
For in-house management, yes in practice. Structural imaging plus threshold fields are the core of diagnosis and of monitoring for progression.
What happens when a patient needs surgery?
Refer to a glaucoma or comprehensive surgeon for laser, MIGS, an implant or incisional surgery. Many patients return to the referring optometrist for ongoing monitoring.
Can optometrists perform SLT?
In some states. Review of Optometry counted 14 states with optometric laser authority as of November 2025, and the list keeps changing.
Where do the drops come from?
Patients fill branded prescriptions at their pharmacy. Practices can order generic glaucoma prescriptions for in-office use from the Vision Rescue Rx catalog.
References
- CDC. Glaucoma: about eye disorders. CDC
- Medicare.gov. Glaucoma tests coverage. Medicare
- New England College of Optometry. Massachusetts expands role of optometrists in glaucoma treatment. NECO
- Review of Optometry. Two scope wins secured in 2025, November 18, 2025. Review of Optometry
- Glaukos. iDose TR billing and coding quick reference guide (H40.1- staging). Glaukos
Turn glaucoma suspects into a managed service
Start with the diagnostics guide, then build your drop formulary and referral path.
Written for licensed eye care professionals. Scope of practice, coding and coverage rules vary by state and payer and change over time; confirm current rules before adding a service. This page is information only, not legal or billing advice.