Medicare Reimbursement for Punctal Occlusion by Plug

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Topic: Punctum Plugs

Sponsor: Oasis Medical

Updated: 07/01/2024

This FAQ addresses the following:

Does Medicare cover punctal occlusion by plug?
What documentation is required in the chart to support medical necessity for this service?
How do we code for punctal occlusion by plug on the claim form?
May we charge for an exam on the same day as the procedure?
What is the Medicare reim-bursement to the physician for 68761?
Is there a facility fee if the procedure is performed in an ASC or HOPD?
How frequently is this procedure performed?
If a plug falls out, may the replacement procedure also be billed?
What if we need to explant a punctal plug?

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The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, and other sources. The reader is strongly encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.

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