APR 22, 2022
Punctal Plug Supply Billing
Are we able to bill patients directly for the lacrimal plugs due to Medicare bundling them with the plug placement procedures?
No. From the Coding Coach clues under CPT code 68761:
Coding Coach: The Complete Ophthalmic Coding Reference (aao.org)
- In 2002, Medicare bundled the supply of the plug with the insertion. It is not appropriate to obtain an ABN and bill the patient.
- Non-Medicare payers may pay separately for the supply of the plug with HCPCS codes:
- A4262 for collagen.
- A4263 for silicone.
- 99070. List punctal plugs as the supply in the free-form text area of the CMS 1500 form.