billing medicare for punctal plugs cpt 687612020 brought some changes to ophthalmology billing. This is the second in our 3-part series on the CPT changes you need to be aware of.

UPDATE: Medicare has updated their payment policy for treating dry eye, CPT codes 68760 and 68761.

The Details

Medicare has updated their payment policy for CPT codes 68760 and 68761 to a bilateral indicator of “1”. This means payment is per eye, not per lid. Use modifiers RT, LT, and -50.

What It Means for Billing

The post-op period for CPT 68760 and CPT 68761 is 10 days. If a patient comes back during the post-op period for complications and the plugs have to be inserted again, use modifier -78 and the appropriate eye modifier.

Medicare bundled the supply of the plug with the insertion in 2002. It’s not appropriate to obtain an ABN and bill the patient for the supply.

Billing #ProTip

When performing multiple or bilateral procedures, the first procedure is paid at the full allowable, and the second and subsequent procedures are reduced to 50% of the allowed amount.

Coding changes have you puzzled?
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