(710) Expansion of Utilization of Office-Based Superior Laryngeal Nerve Block With Associated Medicare Costs, 2018-2024

Introduction: Superior laryngeal nerve (SLN) block, also known as vagal nerve block, is an increasingly utilized office-based intervention for management of refractory laryngeal and neurogenic cough disorders. This study examines national trends in SLN block utilization, reimbursement patterns, provider utilization, and the financial impact on Medicare.

Methods: Medicare beneficiaries undergoing office-based SLN block between 2018 and 2024 were included in a retrospective analysis of the Physician/Supplier Procedure Database from the Center of Medicare and Medicaid Services (CMS). High-volume office-based laryngology procedures were analyzed, with flexible laryngoscopy with injection augmentation selected as a control. Absolute changes in service volume and compound annual growth rate (CAGR) were calculated. Estimated Medicare expenditures were assessed.

Results: Between 2018 and 2024, office-based SLN injection procedures increased from 152 to 2330, a 1433% increase, compared with 72.6% for injection augmentation. Utilization of SLN block increased at a CAGR of 47.7%, compared to 8.1% for the control (mean annual increase: 68.3%). Otolaryngology providers performing SLN block in the office setting increased at a CAGR of 33.2%, versus 5.5% for the control. Average reimbursement per SLN block decreased by 18.9% and increased by 22.3% for the control. SLN block use resulted in small but rapidly growing cost to Medicare between 2018 and 2024.

Conclusions: Office-based SLN block utilization and participating otolaryngology providers increased substantially. Despite decreased average Medicare reimbursement per procedure, overall utilization resulted in increased Medicare expenditures. Further research is needed to evaluate the impact of this shift on patient safety, clinical outcomes, and cost-effectiveness.