ALL PUNCTAL OCCLUSION IS BILLED THE SAME, regardless if permanent silicone plugs or temporary synthetic / collagen inserts are used.

ALLOW AT LEAST 10 DAYS (POST-OP PERIOD) following the insertion of collagen plugs before inserting permanent plugs.

WHEN OCCLUDING MORE THAN ONE PUNCTUM AT THE SAME TIME, the first procedure is allowed at 100% and each additional procedure is allowed at 50%.


In addition to proper coding, be sure the procedure is properly and sufficiently documented.

Document the patient's dry eye complaint.

Be sure to note the patient's pertinent history, symptoms and affect on daily acivities.

Document unsuccessful alternative treatments

This should include the use of artificial tear supplements with continued dry eye symptoms.

Document examination and evaluation of tear production to confirm Dry Eye Syndrome.

This may include ZoneQuick, Schirmer, Rose Bengal Staining, and/or Tear Break-Up Time tests. Some tests may not be superately billable

Document that you have clearly explained to the patient the potential risks and benefits of punctal occlusion.

The Codes to Know

Primary Diagnosis Codes

H04.121 Dry Eye Syndrome of Right Lacrimal Gland

H04.122 Dry Eye Syndrome of Left Lacrimal Gland

H04.123 Dry Eye Syndrome of Bilateral Lacrimal Glands

Secondary Diagnosis Codes

H16.109 Unspecified superficial keratitis

H16.229 Keratoconjunctivitis sicca

H57.8 Redness or discharge

M35.01 Keratoconjunctivitis sicca associated with Sjögren’s disease

CPT Procedure Code

68761 Closure of the lacrimal punctum by plug, each

Supply Code

A4263 (HCPCS) or 99070
Medicare combines the office visit, procedure and supply of collagen/silicone plugs, thus they are not billed separately. Some private insurance may accept a separate supply code

Punctum Identification

E1 Upper lid, left

E2 Lower lid, left

E3 Upper lid, right

E4 Lower lid, right


25 Sperately identifiable service by the same doctor on the same day

50 Bilateral procedures

51 Multiple procedures

NOTE: The information in this guide is believed to be accurate but is not intended to serve as an authority or to comprehensively address proper billing procedures. Always refer to official documentation provided by Medicare and/or private insurance carriers.