Medicare Reimbursement for Punctal Occlusion with Lacrifill

Topic: Punctum Plugs

Sponsor: Nordic Pharma

Updated: 03/25/2024

Nordic Pharma

This FAQ addresses the following:

  1. What is LACRIFILL®?
  2. Does Medicare cover punctal occlusion by plug?
  3. What documentation is required in the chart to support medical necessity for this service?
  4. How do we code for punctal occlusion with LACRIFILL on the claim form?
  5. May we charge for an exam on the same day as the procedure?
  6. What is the Medicare reim-bursement 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. What if we need to explant LACRIFILL?