A4263 — Permanent, long term, non-dissolvable lacrimal duct implant, each
A4263 is a HCPCS Level II code for permanent, long term, non-dissolvable lacrimal duct implant, each. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusB
Bundled code. Payment is always bundled into another service. CMS: 'If RVUs are shown, they are not used for Medicare payment.'
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A4263 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 4 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A4263
- Long descriptor
- Permanent, long term, non-dissolvable lacrimal duct implant, each
- Short descriptor
- Permanent tear duct plug
- Added
- January 1, 1994
- BETOS
- Y1
- Pricing indicator
- 11 — Physician fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Price established using national RVUs.
Codes adjacent to A4263
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4263 is not quite right, the correct code is very often within a few positions of it.
- A4253Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips
- A4255Platforms for home blood glucose monitor, 50 per box
- A4256Normal, low and high calibrator solution / chips
- A4257Replacement lens shield cartridge for use with laser skin piercing device, each
- A4258Spring-powered device for lancet, each
- A4259Lancets, per box of 100
- A4261Cervical cap for contraceptive use
- A4262Temporary, absorbable lacrimal duct implant, each
- A4264Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
- A4265Paraffin, per pound
- A4266Diaphragm for contraceptive use
- A4267Contraceptive supply, condom, male, each
- A4268Contraceptive supply, condom, female, each
- A4269Contraceptive supply, spermicide (e.g., foam, gel), each
- A4270Disposable endoscope sheath, each
- A4271Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 tests
Questions about A4263
What is HCPCS code A4263?
A4263 is a HCPCS Level II code for permanent, long term, non-dissolvable lacrimal duct implant, each. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4263?
The CMS HCPCS file marks A4263 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is A4263 paid under the physician fee schedule?
A4263 carries PFS status code B. Bundled code. Payment is always bundled into another service. CMS: 'If RVUs are shown, they are not used for Medicare payment.'