CPT 68761 Punctal Plug Placement Reimbursement | OpenPayer

Summary & Overview

CPT 68761: Lacrimal Punctal Plug Placement for Dry Eye Syndrome

CPT code 68761 represents the placement of a lacrimal punctal plug to occlude the punctum and reduce excessive tear drainage, commonly used in the treatment of dry eye syndrome. This minor ophthalmic procedure is performed in office or ambulatory surgical settings and is relevant nationally due to the high prevalence of dry eye and the frequency of procedural management options among outpatient eye care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent, typical service settings, and payer coverage considerations. The publication also outlines common modifiers and related billing elements where available, national reimbursement context, and coding best practices for accurate claim submission. Where specific data elements were not provided in the input, the report notes that those items are not available.

This summary equips payers, billing professionals, and clinicians with a clear description of CPT code 68761, helping stakeholders understand its clinical use, expected sites of service, and the payer landscape relevant to national billing and coverage discussions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare68761CPTophthalmologydry eyepunctal plugoutpatient-procedurelacrimalocular-surface

Billing Code Overview

CPT code 68761 describes the placement of a plug to close the lacrimal punctum to block excessive drainage of tears. This procedure is performed to treat dry eye syndrome by reducing tear outflow through the punctal opening.

Service type: Minor ophthalmic punctal occlusion procedure
Typical site of service: Office or ambulatory surgical setting for ophthalmology procedures

Clinical & Coding Specifications

Clinical Context

A 64-year-old female with chronic evaporative and aqueous-deficient dry eye presents to an ophthalmology clinic with persistent ocular irritation, foreign body sensation, and frequent use of lubricating drops with inadequate relief. Conservative measures including artificial tears, topical anti-inflammatory therapy, and punctal occlusion with temporary collagen plugs were tried previously. After shared decision-making, the provider places a permanent or long-term lacrimal punctal plug to reduce tear drainage and improve ocular surface lubrication. The procedure is performed in an outpatient ophthalmology clinic or ambulatory surgical center under topical anesthesia with sterile technique. The clinical workflow includes informed consent, brief ocular examination to confirm punctal patency and anatomy, topical anesthetic and antiseptic application, insertion of the appropriate-sized plug into the upper and/or lower punctum(s), verification of plug position, post-procedure instructions, and documentation of laterality, number of puncta treated, type of plug, and any immediate complications. Typical ancillary services before or after placement may include ocular surface staining, tear film assessment, and follow-up visits to monitor plug retention and symptomatic improvement.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service	Use when an E/M visit on the same day is distinct from the punctal plug procedure.

Related Codes

CPT-68760-PUNCTAL-OCCLUSION-FOR-DRY-EYE

CPT 68760: Punctal Occlusion for Dry Eye Syndrome

CPT-68705-PUNCTAL-CAUTERY-FOR-EVERTED-PUNCTUM

CPT 68705: Punctal Cautery for Everted Punctum

CPT-68750-LACRIMAL-BYPASS-CONJUNCTIVONASAL-FISTULA-WITH-TUBE

CPT 68750: Lacrimal Bypass with Conjunctivonasal Fistula and Tube Placement

CPT-68720-DACRYOCYSTORHINOSTOMY-DCR-NASOLACRIMAL-DUCT-REPAIR

CPT 68720: Dacryocystorhinostomy (DCR) for Nasolacrimal Duct Obstruction

CPT-68745-LACRIMAL-FISTULA-CREATION-CONJUNCTIVA-TO-NOSE

CPT 68745: Lacrimal Fistula Creation Between Conjunctiva and Nose

CPT-68770-LACRIMAL-FISTULA-CLOSURE

CPT 68770: Closure of Lacrimal Fistula

CPT-68700-CANALICULUS-LACERATION-REPAIR-EYE

CPT 68700: Repair of Canaliculus Laceration of the Eye

Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Most common specialty performing punctal plug placement.
`207WP3000X`	Corneal and External Disease	Subspecialists who frequently manage refractory dry eye and punctal occlusion.
`363L00000X`	Optometrist	Optometrists in many states perform punctal plug placement in-office under appropriate scope of practice.
`363LA2200X`	Optometrist - Therapeutic Management	Providers who perform medical procedures for ocular surface disease.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H04.123`	Dry eye syndrome, bilateral	Primary indication for punctal plug placement to reduce tear drainage and improve ocular surface lubrication.
`H04.121`	Dry eye syndrome, right lacrimal	Indication when symptoms/localized dry eye affect the right eye requiring unilateral plug placement.
`H04.122`	Dry eye syndrome, left lacrimal	Indication when symptoms/localized dry eye affect the left eye requiring unilateral plug placement.
`H16.221`	Recurrent erosion of cornea, right eye	Corneal surface disease that may be associated with dry eye and lead to consideration of punctal occlusion.
`H16.222`	Recurrent erosion of cornea, left eye	As above for left eye.
`H11.03`	Conjunctival xerosis	Ocular surface dryness where punctal occlusion may be part of management.
`H04.8`	Other disorders of lacrimal system	Miscellaneous lacrimal conditions where punctal occlusion may be therapeutic.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`68761`	Closure of lacrimal punctum by plug (occlusion), by provider placement	Primary procedure for punctal plug insertion to reduce tear drainage in dry eye management.
`92002`	Ophthalmological services: medical examination and evaluation, new patient; intermediate, with initiation of diagnostic and treatment program	Performed when a new patient evaluation leads to decision for punctal plug placement (or use `92004` for comprehensive new patient exam).
`92012`	Ophthalmological services: intermediate, established patient; with initiation or continuation of diagnostic and treatment program	Used for established patient visits documenting evaluation prior to or after plug placement.
`99173`	Screening test of visual acuity, quantitative, bilateral	May be performed as part of pre- or post-procedure assessment when visual acuity documentation is required.
`99024`	Postoperative follow-up visit, normally included in the global service, following surgery during global period	Used when reporting routine post-procedure follow-up if payer requires explicit reporting (check global period rules).