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    v1.0.28
    OpenPayerBilling CodesMedical And Surgical SuppliesHCPCS hcpcs-a4263-permanent-lacrimal-duct-implant
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    HCPCS Level II A4263: Permanent Lacrimal Duct Implant, Non-dissolvable

    HCPCS Level II code A4263 describes a permanent, long-term, non-dissolvable lacrimal duct implant supplied for ophthalmic use; the service is the provision of the implant device for insertion into the lacrimal drainage system and is typically associated with ophthalmology procedures performed in an ambulatory surgery center or hospital outpatient setting where lacrimal duct reconstruction or stenting is completed.

    For related coverage guidance, see recent payer policy updates: Salivary Hormone Testing, Bone Turnover Markers Testing, Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient presents to an oculoplastic surgeon with chronic epiphora (tearing) and recurrent dacryocystitis due to nasolacrimal duct obstruction refractory to conservative measures and previous failed probing and stenting. After diagnostic dacryocystography and office lacrimal irrigation confirm a distal lacrimal drainage obstruction, the surgeon schedules a lacrimal drainage reconstruction that will include placement of a permanent, long-term, non-dissolvable lacrimal duct implant (A4263) to maintain patency of the canaliculus-to-nasal passage. The procedure is typically performed in an ambulatory surgical center or hospital outpatient department under monitored anesthesia care or general anesthesia. Typical workflow: preoperative evaluation and informed consent, intraoperative lacrimal probing and dilation, creation or revision of the nasolacrimal ostium (if indicated), placement of the permanent lacrimal implant (A4263), intraoperative confirmation of irrigation through the implant, and postoperative instructions with topical antibiotics and follow-up lacrimal irrigation to verify continued patency. Common settings include oculoplastic clinics, ophthalmology ambulatory surgery centers, and hospital outpatient departments. The device A4263 is billed per implant placed; bilateral procedures require separate implants and appropriate laterality modifiers such as LT and RT when applicable.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    67840Dilation of lacrimal punctum; without probing and irrigationMay be performed in-office prior to deciding on permanent implant when diagnosing or relieving partial obstruction.
    68740Repair of canaliculus, with or without stent, canalicular repairPerformed when canalicular injury or stenosis is present and repair is needed in conjunction with implant placement.
    68270Excision or destruction of lesion of lacrimal apparatusRarely used; listed when adjunctive procedures on the lacrimal sac are required during implant placement.
    68820Incision and drainage, lacrimal sac (external)Performed for active dacryocystitis that may precede definitive implant placement after infection control.
    31254Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial or totalENT endoscopic procedures such as endoscopic dacryocystorhinostomy may be performed alongside placement of lacrimal implants in combined approaches.
    99070Supplies and materials (e.g., sterile tray, specialized implants)

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    103T00000XPsychologistA psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
    347D00000XTrainAn organization or business licensed to provide passenger train service, including light rail, subway, and traditional services.
    213ER0200XRadiology PodiatristPodiatric Medicine & Surgery Service Providers · Podiatrist
    1835P2201XAmbulatory Care PharmacistA licensed pharmacist who has demonstrated specialized knowledge and skill in the provision of integrated, accessible health care services by pharmaci…

    Related ICD-10-CM Codes

    13 rows

    ICD-10-CM CodeDescription
    H02.821Cysts of right upper eyelid
    H02.829Cysts of unspecified eye, unspecified eyelid
    H04.223Epiphora due to insufficient drainage, bilateral
    H04.9Disorder of lacrimal system, unspecified
    H10.9Unspecified conjunctivitis
    H11.10Unspecified conjunctival degenerations
    H16.9Unspecified keratitis
    H18.49Other corneal degeneration
    H57.10Ocular pain, unspecified eye
    H57.89Other specified disorders of eye and adnexa

    Showing 1–10 of 13

    Related Payer Policy Updates

    Specialty: Endocrinology1 / 3

    5 rows

    PolicyPayerEffective Date
    Salivary Hormone TestingOscar Health2026-10-01
    Bone Turnover Markers TestingOscar Health2026-10-01
    Parathyroid Hormone, Phosphorus, Calcium, and Magnesium TestingOscar Health2026-10-01
    Testosterone — Coverage Criteria for Measurement and MonitoringOscar Health2026-10-01
    Thyroid Disease TestingOscar Health2026-10-01

    Related Codes

    HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

    HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

    HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

    HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

    HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

    HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

    HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

    HCPCS Level II A4210: Needle-free Injection Device, Each

    HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

    HCPCS Level II A4211: Supplies for Self-Administered Injections

    HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

    HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

    HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

    HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

    HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

    HCPCS Level II A4215: Needle, Sterile, Any Size

    HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

    HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

    Showing 1–10 of 633

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Used when billing for non-implant supplies associated with the procedure; note that the implant itself is billed with A4263.