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punctal plugs

Tobi Posted Fri 18th of May, 2012 20:38:27 PM

I am billing to medicare and ppo 68761 w/ modifiers e1 e2 e3 e4 depending on where plug is inserted, also for supply A4263 with same modifiers. the 68761 code is getting paid but the supply code is not it is saying code or modifier is invalid? did code change? is this a non covered service? Can I bill patient for the plugs?

Tobi Posted Fri 18th of May, 2012 20:40:09 PM

'68761' 'A4263' with modifiers 'e1 e2 e3 e4' depending on where inserted.

SuperCoder Answered Fri 18th of May, 2012 20:52:29 PM

Most non-Medicare payers will pay for the supply of the punctal plugs: Use HCPCS codes A4262 for collagen plugs and A4263 for silicone plugs. If the payer doesn’t recognize HCPCS codes, use the supply code 99070. List punctal plugs as the supply in the free-form text area of the HCFA 1500 claim form. You may have to attach an invoice showing your cost for the supply of the plugs.

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