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Permanent, long term, non-dissolvable lacrimal duct implant, each

HCPCS code

Name of the Procedure:

Permanent, long term, non-dissolvable lacrimal duct implant, each (HCPCS Code A4263)


This procedure involves the insertion of a permanent, long-term, non-dissolvable implant into the lacrimal duct (tear duct) to help maintain tear drainage and alleviate symptoms such as chronic eye dryness or excessive tearing.


The procedure is designed to address issues with tear drainage, such as chronic dry eye syndrome or excessive tearing (epiphora). The goal is to provide a long-lasting solution that improves tear drainage and eye comfort.


  • Chronic dry eye syndrome
  • Epiphora (excessive tearing)
  • Lacrimal duct obstructions
  • Patients not responding to other less invasive treatments


  • Patients may need to fast for a few hours before the procedure (typically if sedation is used).
  • Medication adjustments may be necessary based on the patient’s current prescriptions.
  • Diagnostic tests like tear duct imaging and lacrimal drainage assessments may be required.

Procedure Description

  1. Anesthesia: Local anesthesia is typically applied to numb the area.
  2. Dilation: The lacrimal punctum (tear duct opening) is gently dilated.
  3. Insertion: A special tool is used to insert the non-dissolvable implant into the lacrimal duct.
  4. Secure Placement: Ensuring the implant is securely positioned to prevent migration and promote proper drainage.


The procedure generally takes about 20-30 minutes.


The procedure is usually performed in an outpatient clinic or a surgical center.


  • Ophthalmologist or Eye Surgeon
  • Nurse or Medical Assistant

Risks and Complications

  • Common Risks: Discomfort, infection, minor bleeding.
  • Rare Risks: Implant displacement, scarring, or allergic reaction to the implant material.
  • Management: Most complications can be managed with medications or minor adjustments.


  • Improved tear drainage
  • Relief from symptoms of dry eye or excessive tearing
  • Long-term solution with minimal need for ongoing treatment


  • Post-procedure Care: Use of prescribed eye drops to prevent infection and ease discomfort.
  • Recovery Time: Most patients resume normal activities within a day.
  • Restrictions: Avoid rubbing eyes and strenuous activities for a short period.
  • Follow-up: A follow-up appointment is usually scheduled within a week to ensure proper placement and healing.


  • Punctal Plugs: Short-term, dissolvable solutions that may not be suitable for all patients.
  • Eye Drops: May offer temporary relief but are less effective as a long-term solution.
  • Surgical Correction: More invasive options that carry higher risks and longer recovery times.

Patient Experience

  • During Procedure: Mild discomfort due to the dilation of the tear duct.
  • After Procedure: Some soreness and minor swelling which typically resolves within a few days.
  • Pain Management: Over-the-counter pain relievers and prescribed eye drops can help manage discomfort.

Medical Policies and Guidelines for Permanent, long term, non-dissolvable lacrimal duct implant, each

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