A4263 HCPCS code: Permanent, long term, non-dissolvable lacrimal duct implant, each
A4263 is the HCPCS Level II code for permanent, long term, non-dissolvable lacrimal duct implant, each. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 4 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 11 — Priced using national relative value units (Physician Fee Schedule) |
| BETOS category | Y1 |
| Added | 1994-01-01 |
| Last action effective | 1998-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 4 | Anatomic Consideration |
What changed for A4263
- 1994-01-01: A4263 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4263?
A4263 is the HCPCS Level II code for permanent, long term, non-dissolvable lacrimal duct implant, each. Short descriptor: "Permanent tear duct plug".
Does Medicare cover A4263?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of A4263 can be billed per day?
4 on outpatient hospital claims (NCCI medically unlikely edits).
Related A42 codes
- A4206 — Syringe with needle, sterile, 1 cc or less, each
- A4207 — Syringe with needle, sterile 2 cc, each
- A4208 — Syringe with needle, sterile 3 cc, each
- A4209 — Syringe with needle, sterile 5 cc or greater, each
- A4210 — Needle-free injection device, each
- A4211 — Supplies for self-administered injections
- A4212 — Non-coring needle or stylet with or without catheter
- A4213 — Syringe, sterile, 20 cc or greater, each
- A4215 — Needle, sterile, any size, each
- A4216 — Sterile water, saline and/or dextrose, diluent/flush, 10 ml ($0.53–$0.99)
- A4217 — Sterile water/saline, 500 ml ($2.18–$4.93)
- A4218 — Sterile saline or water, metered dose dispenser, 10 ml
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Next steps
- Run a reimbursement report for a device billed under A4263
- Watch A4263 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4263
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.