Medicare Reimbursement for Punctal Occlusion by Punctal Plug

Topic: Punctum Plugs

Sponsor: OASIS Medical

Updated: 02/03/2023

OASIS Medical

This FAQ addresses the following:

  1. Does Medicare cover punctal occlusion with plug?
  2. What are the indications for punctal occlusion with plug?
  3. What documentation is required in the chart to support medical necessity for this service?
  4. How do we indicate on the claim form which puncta were treated?
  5. May we charge for an exam on the same day as the procedure?
  6. What is the Medicare reimbursement to the physician for 68761?
  7. Is there a facility fee if the procedure is performed in an ASC or HOPD?
  8. How frequently is this procedure performed?
  9. If a plug falls out, may the replacement procedure also be billed?
  10. What if we need to explant a punctal plug?