Summary & Overview
CPT 0360T: Drug-Eluting Implant Insertion in Lacrimal Canaliculus
CPT code 0360T represents the insertion of a drug-eluting implant into the lacrimal canaliculus, a procedure commonly performed in ophthalmology to treat conditions such as dry eye syndrome and nasolacrimal duct stenosis. This minimally invasive intervention delivers medication directly to the eye, offering targeted therapy and improved patient outcomes. The procedure is typically conducted in an office setting, making it accessible and convenient for both providers and patients.
This publication provides a comprehensive overview of CPT code 0360T, including its clinical context, typical site of service, and relevance in ophthalmic practice. Key payers covered in the analysis include Blue Cross Blue Shield and Cigna Health, reflecting major national insurers' policies and coverage for this procedure. Readers will gain insights into current benchmarks, policy updates, and the clinical applications of drug-eluting implants in the management of lacrimal system disorders. The report also highlights related CPT codes and common modifiers used in billing, offering a clear understanding of coding practices and payer requirements. This resource is designed to inform healthcare professionals, administrators, and policy analysts about the latest developments and considerations surrounding CPT code 0360T.
CPT Code Overview
CPT code 0360T describes the insertion of a drug-eluting implant into the lacrimal canaliculus, including punctal dilation and implant removal when performed. This procedure is typically performed in an office setting and falls under the service type of ophthalmology. The drug-eluting implant is used to deliver medication directly to the eye, providing targeted treatment for conditions affecting the lacrimal system. The office-based nature of this service allows for efficient patient care and management of ocular conditions.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to an ophthalmology office with symptoms of chronic dry eye syndrome or nasolacrimal duct stenosis. The patient may have tried conservative treatments such as artificial tears or topical medications without sufficient relief. After evaluation, the provider determines that insertion of a drug-eluting implant into the lacrimal canaliculus is appropriate to deliver sustained medication and improve tear production or duct patency. The procedure is performed in the office setting, often under local anesthesia, and may include punctal dilation and removal of a previous implant if necessary. The workflow includes pre-procedure assessment, implant insertion, and post-procedure monitoring for efficacy and complications.
Coding Specifications
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Modifiers:
50- Bilateral Procedure: Used when the drug-eluting implant is inserted into both lacrimal canaliculi during the same session.LT- Left Side: Used when the procedure is performed on the left lacrimal canaliculus.RT- Right Side: Used when the procedure is performed on the right lacrimal canaliculus.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207W00000X | Ophthalmology |
152W00000X | Optometrist |
207WX0009X | Ophthalmic Plastic and Reconstructive Surgery |
- Specialties Represented:
- Ophthalmology: Medical and surgical eye care.
- Optometrist: Non-surgical eye care and management.
- Ophthalmic Plastic and Reconstructive Surgery: Specialized surgical procedures involving the eye and surrounding structures.
Related Diagnoses
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H04.121- Dry eye syndrome of right lacrimal gland- Indicates dry eye affecting the right side; relevant for implant insertion in the right canaliculus.
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H04.122- Dry eye syndrome of left lacrimal gland- Indicates dry eye affecting the left side; relevant for implant insertion in the left canaliculus.
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H04.123- Dry eye syndrome of bilateral lacrimal glands- Indicates dry eye affecting both sides; supports bilateral implant insertion.
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H04.129- Dry eye syndrome of unspecified lacrimal gland- Used when laterality is not specified; supports implant insertion when side is unclear.
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H04.531- Stenosis of right nasolacrimal duct- Indicates narrowing of the right duct; implant may be used to improve patency or deliver medication.
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H04.532- Stenosis of left nasolacrimal duct- Indicates narrowing of the left duct; implant may be used to improve patency or deliver medication.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
68761 | Closure of the lacrimal punctum; by plug, each | Used for occluding the punctum to treat dry eye; may be an alternative or adjunct to drug-eluting implants. |
68801 | Dilation of lacrimal punctum, with or without irrigation | Often performed prior to implant insertion to facilitate access; may be included in the workflow. |
68810 | Probing of nasolacrimal duct, with or without irrigation | Used to treat nasolacrimal duct obstruction; may be performed before or instead of implant insertion. |
68815 | Probing of nasolacrimal duct, with or without irrigation, requiring general anesthesia | Similar to 68810, but for cases requiring general anesthesia; less commonly performed with implants. |
- Commonly Used Together:
68801may be performed in conjunction with0360Tfor punctal dilation.
- Alternatives:
68761may be used instead of0360Tfor punctal occlusion in dry eye management.68810and68815are alternatives for treating duct obstruction when implant insertion is not indicated.
National Reimbursement Benchmarks
For CPT code 0360T, national mean rates for Blue Cross Blue Shield are significantly lower than those for BUCA (average commercial) and Cigna. Blue Cross Blue Shield's mean rate is $22.32, while BUCA and Cigna are both around $62.50. Medicare rates are not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is tightest for Blue Cross Blue Shield, with all percentiles at $14.00, indicating no variation. BUCA and Cigna both show a narrow range, with the 75th percentile only about $1.13 higher than the 25th percentile, reflecting minimal rate variation among commercial payers.
The table and chart below present the full breakdown of national benchmarks for CPT code 0360T across the available payers.
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