DEC 11, 2019
Billing Plugs to Commercial Payer
Question: While Medicare bundles punctal plugs into the insertion code, I thought commercial payers pay separately, however A4263 for silicone, is being denied. Is there another code we should bill?
Answer: Commercial payers that do not follow Medicare Part B rules may allow the supply of the plug to be billed separately. You will need to verify with each of your payers. There are three codes that may be applicable:
A4263 for silicone, A4262 for collagen or try using 99070 Supplies and materials provided by the physician. Be sure to include in box 19 that the supply is for punctal plugs.
Learn more about plugs in the Oculofacial module.