Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation

Nasal punctum dilation and nasolacrimal duct probing (with or without irrigation) are covered when obstruction at or distal to the puncta is reasonably suspected to cause epiphora, chronic dacryocystitis, mucocele, or lacrimal sac infection requiring relief (including preoperative clearance). Prior to these procedures, medical records must document a thorough lacrimal evaluation (history and physical including slit lamp), exclusion or treatment of pre-punctal/non-obstructive causes, and appropriate non-invasive testing to localize obstruction; several anatomic or infectious conditions (e.g., lacrimal sac tumor, bony canal malformation, recurrent active dacryocystitis, post-traumatic bony narrowing, dacryocystolithiasis) are contraindications. Diagnostic tests such as Schirmer, TBUT, dye disappearance, Jones, and saccharine are part of the ophthalmologic exam and are not separately reimbursable; service provision is also subject to state regulations and provider scope of practice.