Reimbursement Guidelines for Punctal Occlusion by Plug

Punctal occlusion by plug provides a therapeutic alternative when eye drops and ointments have proven unsatisfactory for the treatment of dry eyes.  Punctal occlusion has made many patients much more comfortable.

A drop of anesthesia on the punctum is commonly used.  The plug is inserted into the punctum (or vertical canal for intracanalicular plugs).

This monograph is intended to address the reimbursement issues associated with punctal occlusion utilizing punctum plugs.  Medicare reimbursement for this procedure involves a number of issues.  These include:  Medicare coverage guidelines, the locations where services are rendered, and coding systems that apply to claims submission.  This discussion addresses all of these variables in order to provide the reader with a comprehensive understanding of the topic.


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