Closure of Tear Duct Using Plug; CPT Code 68761: Billing Guidelines

North Carolina Medicaid requires claims for CPT code 68761 be billed with one of the following modifiers:

• E1 – Left Upper Eyelid
• E2 – Left Lower Eyelid
• E3 – Right Upper Eyelid
• E4 – Right Lower Eyelid

When more than one punctum is occluded at the same time, multiple surgery rules apply. The first procedure is allowed at 100% and each additional procedure is allowed at 50%. When multiple punctal plugs are placed during an encounter, each subsequent eyelid must be billed with modifier 51 for the claim to process correctly.

An example of the correct way to submit a claim for the placement of four punctal plugs is provided below:

68761 - E2         pay 100% allowable
68761 - E4 51    pay 50% allowable
68761 - E1 51    pay 50% allowable
68761 - E3 51    pay 50% allowable

Contact

NCTracks Call Center: 800-688-6696