Summary & Overview
HCPCS A4262: Temporary, Absorbable Lacrimal Duct Implant, Each
HCPCS Level II code A4262 identifies a temporary, absorbable lacrimal duct implant supplied for each unit used. These implants are used in ophthalmic procedures to preserve or restore tear drainage function after duct procedures and are relevant to surgical supply billing and device reimbursement nationally. The code matters because it affects perioperative supply charges in eye surgery and impacts device categorization for payers and Medicare.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how A4262 is classified, the clinical contexts that typically use the device, and which major payers are considered. The publication summarizes available benchmarks and payer coverage patterns where present, highlights policy and coding considerations affecting claim processing, and situates the code within surgical supply and ophthalmology service lines.
The report also outlines practical billing elements: typical site-of-service usage, service-line implications for ophthalmology and ambulatory surgery, and points of attention for aligning device supply charges with payer documentation requirements. Data not provided in the input are noted as unavailable.
Billing Code Overview
HCPCS Level II code A4262 describes a temporary, absorbable lacrimal duct implant, each. This item is a small medical implant used to temporarily maintain patency of the lacrimal (tear) drainage system following procedures that risk ductal collapse or occlusion. The service type is implantable medical device. The typical site of service is ophthalmology or ocular surgery settings, including ambulatory surgical centers and hospital outpatient departments where lacrimal procedures are performed.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric patient with symptomatic nasolacrimal duct obstruction, persistent epiphora (tearing), or recurrent dacryocystitis referred to an ophthalmologist or oculoplastic surgeon. The procedure involves placement of a temporary, absorbable lacrimal duct implant (A4262) during an in-office or ambulatory surgical setting. The clinical workflow begins with pre-procedure assessment (history, ocular exam, fluorescein dye disappearance test, and lacrimal irrigation/probing), informed consent, and topical or local anesthesia with sedation as needed. Under microscopic or endoscopic visualization, the surgeon performs dilation or probing of the canaliculi/nasolacrimal duct and places the absorbable implant to stent the duct and maintain patency while healing occurs. The implant is intended to be absorbable and therefore does not require scheduled removal. Post-procedure care includes topical antibiotics and anti-inflammatory drops, short-term follow-up at 1 week to assess position and at 4–6 weeks to document symptomatic improvement and healing. Typical sites of service are the ophthalmologist’s office procedure room, ambulatory surgery center (ASC), or hospital outpatient department depending on patient comorbidity and anesthesia needs. Common clinical indications include congenital nasolacrimal duct obstruction, acquired nasolacrimal duct stenosis, or postsurgical nasolacrimal scarring requiring temporary stenting.
Coding Specifications
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