Summary & Overview
HCPCS A4263: Permanent Lacrimal Duct Implant, Non-Dissolvable
HCPCS Level II code A4263 denotes a permanent, long-term, non-dissolvable lacrimal duct implant, each. This implantable ophthalmic device is used to maintain lacrimal drainage patency and is relevant to surgeons, device manufacturers, and payers given its role in long-term management of tear drainage disorders. Nationally, device codes like A4263 matter for coverage determinations, device reimbursement policies, and ambulatory surgical billing.
Key payers covered in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose and typical sites of service, plus coverage and billing considerations commonly reviewed by these payers.
This publication provides: (1) a clear description of what A4263 represents in clinical practice; (2) an outline of typical billing contexts and sites of service for lacrimal duct implant procedures; and (3) identification of common payer stakeholders relevant to coverage determinations. Where specific payer policies, modifiers, taxonomies, diagnosis mappings, or related codes are required, those details are noted as separate sections or indicated as not available in the input.
Billing Code Overview
HCPCS Level II code A4263 describes a permanent, long term, non-dissolvable lacrimal duct implant, each. This item is a durable implantable device intended to maintain patency of the lacrimal drainage system.
-
Service type: Implantable ophthalmic device placement (device component)
-
Typical site of service: Ophthalmology clinic, ambulatory surgical center, or hospital outpatient setting where lacrimal duct procedures and device implantations are performed.
Data not available in the input.
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.
Coding Specifications
| Modifier | Description |
|---|