How to Correctly bill Permanent Lacrimal Punctum Plugs?

CPT code 68761(closure of the lacrimal punctum; by plug, each) should be used to report the lacrimal procedure. This procedure is based on per puncta, not per eye so in situations where two puncta are treated in the same eye, multiple surgery rules apply. So report each service as a separate line item, adding modifier-51 to the second and any subsequent procedure. If performed in both eyes, bilateral payment rules apply, so report this procedure code with a modifier-50. This code is same whether you used temporary( collagen) or permanent(silicone) plugs. Medicare does not allow separate reimbursement for the supply of the plug(s), however certain commercial payers do. Check with payers if the supply of the plug(s) are covered. If it is covered, report the supply codes with A4262[Temporary, absorbable lacrimal duct implant, each] or A4263[Permanent, long term, nondissolvable lacrimal duct implant, each].