Medicare Reimbursement for Punctal Occlusion by Plug

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Topic: Punctum Plugs

Sponsor: Oasis Medical

Updated: 04/01/2025

This FAQ addresses the following:

Does Medicare cover punctal occlusion by plug?
What chart documentation is required to support medical necessity for this procedure?
What CPT code is used on a claim form to report punctal occlusion by plug?
May we charge for an exam on the same day as the procedure?
What is the Medicare physician reimbursement for 68761?
Does punctal occlusion for DED impact reimbursement for cataract surgery?
How frequently is this procedure performed?
If a plug falls out prematurely, may a replacement procedure 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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