Prior authorization is not required for punctal plugs.
Punctal plugs are generally covered subject to the indications listed below and per your plan documents.
Indications that are covered
Punctal plugs are covered when conservative measures for severe eye dryness have failed.
Dry eye syndrome is a collection of symptoms that make up an eye condition that stems from an imbalance in the quantity or the quality of tears. These symptoms include dry, red, gritty and even watery eyes. If untreated, severe dry eye syndrome can damage tissue and possibly scar the cornea of the eye.
Punctal or punctum plugs are used to treat severe dry eye syndrome. A soft silicone plug, about the size of a sesame seed, is non-surgically inserted into the natural punctal opening. Punctal occlusion allows natural tears to be retained on the eye longer. The entire procedure can be performed in a doctor's office within a few minutes. It is considered a permanent treatment for dry eyes. However, punctal/punctum plugs can be removed if problems arise.
If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.
This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.