CPT 0360T: Insertion of Drug-Eluting Implant into Lacrimal Canaliculus - OpenPayer

Summary & Overview

CPT 0360T: Insertion of Drug-Eluting Implant into Lacrimal Canaliculus

CPT code 0360T represents the insertion of a drug-eluting implant into the lacrimal canaliculus, a minimally invasive ophthalmic procedure that can include punctal dilation and implant removal when performed. The code reflects a growing niche in procedural dry eye and lacrimal drainage disorder management by providing localized, sustained drug delivery directly within the punctal/canalicular system. Nationally, this code matters as payers and providers navigate coverage, appropriate use, and coding alignment for novel implant therapies in eye care. Key payers discussed include Aetna, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise clinical and billing orientation to CPT code 0360T, including the procedure’s clinical context and typical sites of service, related procedural codes for lacrimal interventions, and which diagnoses commonly align with its use. The publication also summarizes benchmark issues and policy considerations relevant to adoption and reimbursement of device-based canalicular therapies. Data not available in the input for some specific payer coverage policies and utilization benchmarks are noted where applicable.

AetnaCigna HealthUnitedHealthcareMedicare0360TCPTlacrimal canaliculusdrug-eluting implantophthalmologydry eyeprocedural codinglacrimal drainage

Billing Code Overview

CPT code 0360T describes the insertion of a drug-eluting implant into the lacrimal canaliculus, and includes punctal dilation and implant removal when performed. This procedure is a targeted treatment for disorders of the lacrimal drainage system, most commonly used in managing symptoms related to tear film dysfunction and canalicular obstruction.

Service type: minor ophthalmic implant procedure

Typical site of service: ambulatory surgical center or ophthalmology clinic procedural suite

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with symptomatic dry eye refractory to topical therapies presents to an ophthalmic plastic surgeon. The patient reports persistent tear film instability and ocular surface irritation with lubrication drops providing inadequate relief. Clinical exam demonstrates punctal stenosis and reduced tear meniscus height; irrigation suggests partial lacrimal outflow obstruction. After shared decision-making, the surgeon performs insertion of a drug-eluting implant into the affected lacrimal canaliculus (0360T) to deliver sustained anti-inflammatory medication. The procedure typically occurs in an ambulatory surgical center or ophthalmologists procedure room under local anesthesia with topical and/or injectable anesthetic. The workflow includes pre-procedure consent and documentation of indications (e.g., H04.121, H04.122, H04.123, H04.129, H04.531, H04.532), punctal dilation as needed, implantation of the drug-eluting device into each treated canaliculus, and implant removal when performed. Post-procedure documentation covers laterality, number of implants, implant removal (if performed), immediate procedural findings, and post-op instructions. Typical sites of service are outpatient ophthalmology clinics, procedure rooms, and ambulatory surgical centers.

Coding Specifications

Modifier

CPT 0366T: Deleted Interventional Cardiovascular Procedure

cpt-0368t-behavior-treatment-modified-additional

CPT 0368T: Behavior Treatment Modified Additional

cpt-0361t-ct-heart-with-contrast-during-cardiac-catheterization-3d-postprocessing

CPT 0361T: Heart CT with Contrast During Cardiac Catheterization, 3D Postprocessing

0367

CPT 0367T: Adaptive Behavior Treatment (Deleted Code)

cpt-0372t-fluorescence-wound-imaging-bacterial-detection

CPT 0372T: Non-Contact Fluorescence Wound Imaging for Bacterial Detection

0371

CPT 0371T: Non-Invasive Central Arterial Pressure Analysis

cpt-97155-adaptive-behavior-treatment-with-protocol-modification

CPT 97155: Adaptive Behavior Treatment with Protocol Modification

97153

CPT 97153: Adaptive Behavior Treatment Procedures, Technician-Administered

97151

CPT 97151: Adaptive Behavior Assessment Procedures

cpt-97152-technician-behavioral-assessment-destructive-behavior

CPT 97152: Technician Assessment of Destructive and Behavioral Problems

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Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Surgeons and physicians who frequently perform lacrimal procedures and device implantation
`152W00000X`	Optometrist	May be involved in diagnosis, pre- and post-procedure care depending on scope-of-practice and state rules
`207WX0009X`	Ophthalmic Plastic and Reconstructive Surgery	Subspecialists who commonly perform lacrimal canalicular and nasolacrimal procedures and device placement

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H04.121`	Dry eye syndrome of right lacrimal gland	Indicates symptomatic ocular surface disease of the right eye that may be managed with sustained local drug delivery via canalicular implant
`H04.122`	Dry eye syndrome of left lacrimal gland	Indicates symptomatic ocular surface disease of the left eye appropriate for consideration of left canalicular implant
`H04.123`	Dry eye syndrome of bilateral lacrimal glands	Bilateral disease where implants may be placed in one or both canaliculi depending on symptoms and clinical judgment
`H04.129`	Dry eye syndrome of unspecified lacrimal gland	Used when laterality is not specified in documentation but the diagnosis supports consideration of the implant
`H04.531`	Stenosis of right nasolacrimal duct	Structural outflow impairment that may contribute to symptoms and influence choice of canalicular interventions
`H04.532`	Stenosis of left nasolacrimal duct	Structural outflow impairment on the left side relevant to treatment planning and procedural approach

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`68761`	Closure of the lacrimal punctum; by plug, each	Alternative or adjunctive treatment for punctal disorders; may be performed when occlusion rather than drug delivery is chosen
`68801`	Dilation of lacrimal punctum, with or without irrigation	Often performed immediately prior to insertion of the implant to facilitate access to the canaliculus
`68810`	Probing of nasolacrimal duct, with or without irrigation	Performed when obstruction of the nasolacrimal duct is suspected; may precede or accompany implant placement if probing is indicated
`68815`	Probing of nasolacrimal duct, with or without irrigation, requiring general anesthesia	Used in similar clinical scenarios as `68810` when general anesthesia is required, for example in uncooperative patients or complex cases

`25`	Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure	Use when a distinct E/M visit is performed and documented on the same day as `0360T` beyond usual pre- and post-procedure care
`51`	Multiple procedures	Use when more than one distinct procedure (other than additional identical `0360T` units billed per canaliculus) is performed during the same session, per payer rules
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure or service that is not normally billed together with `0360T` when documentation supports separate sites/conditions
`76`	Repeat procedure or service by same physician	Use if the same procedure is repeated later the same day by the same provider
`77`	Repeat procedure by another physician	Use if a different physician repeats the procedure the same day
`52`	Reduced services	Use when the service was partially reduced or not completed as documented (e.g., attempted but incomplete implant placement)
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	Use for unplanned returns to address complications related to the implant or procedure
`79`	Unrelated procedure or service by same physician during postoperative period	Use when an unrelated procedure is performed during the global period of `0360T` and documentation supports unrelatedness
`24`	Unrelated E/M service during postoperative period	Use when an E/M visit during the global period is for a reason unrelated to the procedure and is separately documented
`57`	Decision for surgery	Use when an E/M service results in the initial decision to perform `0360T` on the same day as the major procedure (when applicable under payer rules)

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