How Much Do Punctal Plugs Cost?


Written by:  Howmuchisit.org Staff
Last Updated:  August 15, 2018

Punctal plugs are a tiny medical device that is inserted into the tear ducts to block the drainage.

Also referred to as a punctum plug or occluder, these devices are no larger than a small grain of rice.

Eye by illustir, on Flickr
Eye” (CC BY 2.0) by illustir

 

How much do punctal plugs cost?

The cost of punctal plugs will depend on the doctor you go to, the type of punctal plug, where you live and if insurance is involved. On average, punctal plugs will cost anywhere from $350 to $650 without health insurance.

A member on this Vision Surgery Rehab Network forum thread said he was billed $480 to have temporary collagen punctal plugs inserted and this didn’t include the price of the permanent silicone plugs to be inserted in the future.  The second appointment, even though he canceled it, would have been an additional $480, bringing the grand total to $960 without insurance.  After his insurance kicked in, he was responsible for $96.

As long as the procedure is medically necessary, most major insurance companies will cover the procedure.  In most cases, the insurance companies will request supportive documentation and medical records will be required to make a final decision.  The Medicare allowance, for example, is said to be about $230 per eye or close to $530 for both eyes.  With Medicare, they require a trial with collagen to assure the patient will benefit from the plugging, followed by an assessment to track the results.  If the candidate benefits, then the permanent silicone plugs will be used.

For example, on this forum thread on HealthBoards.com, one member had paid $75 after her insurance paid.  Another member on the same forum thread said she was billed $644; however, she was only responsible for her co-pay.

Punctal plugs overview

These plugs are often made of silicone, but temporary plugs, which dissolve over time, can be made of collagen and are designed to see if a patient can benefit from the plugging.  In most cases, a doctor may want to try the collagen plugs first to see if you can benefit.  A few weeks later, you will then come in for an assessment so the doctor can track your results.  If they feel you do benefit from these plugs, then a permanent silicon plug will be used; however, as DryEyeZone.com claims, be forewarned with the term “permanent” since these plugs do have a high loss rate.

During the procedure, and depending on what type of plug is being used, your doctor may first use a specialized instrument in order to measure your tear duct size and the opening.  This measurement will help determine how larger the plug needs to be in order to adequately block the channel and keep it in place.  To help prepare, a local anesthetic may be used, but in most cases, it isn’t recommended, according to AllAboutVision.com.  Next, the punctal plugs will be either inserted into the lower lid, upper lid or both.  Available in different designs, most plugs will be squeezed into place using a variety of different tools.

Various types of punctal plugs exist on the market, including an umbrella, tapered, hollow, reservoir or slanted-like style.  An umbrella design won’t disappear in the tear duct and can be removed if necessary.  Tapered punctal plugs keep the plug in place by placing extra force horizontally.  A hollow punctal plug will have a hollow interior to help the plugs adhere to the shape of your eye’s ducts.  A reservoir type can capture and hold the tears, essentially reducing discomfort.  Lastly, a slanted-like plug can help maintain comfort and stability.

What are the extra costs?

As mentioned, most doctors may want to test temporary plugs before inserting a permanent solution.  All depending on the billing situation, this can, sometimes, increase the costs by more than double the estimates mentioned above.  Be sure to talk with your doctor’s office to see what you will be responsible for.

Quite frequently, patients often find their plugs falling out, even though it’s considered a “permanent” solution.  Again, depending on the situation, you may be required to pay additional fees for a doctor’s visit.

Over time, your plugs may cause discomfort and/or a reaction.  In this situation, your eye doctor will simply flush the plugs out, effectively removing them, but he or she may charge a doctor office visitation fee.

Tips to know

Punctal plugs are often recommended when either non-prescription and/or prescription eye drops fail to help your dry eye condition.  They can also be used after a LASIK procedure.

While rare, side effects may occur such as excessive tearing if the plugs do the job too well.  You can also lose your plug over time and can occur for various reasons, such as rubbing your eyes excessively or dislodging the device.  Infections, while rare, can also occur due to a rare reaction with the plugs.  If this were the case, you would be treated with antibiotics or the plugs would be removed.


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Average Reported Cost: $412

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How much did you spend?

Was it worth it?  

  1. Lilly (Lawndale,  California) paid $412 and said:

    The Doctor billed me for the trial plugs $600.00 and I have to pay out of my pocket $412.00.
    I am not sure how much will be the permanent plugs. I have Blue Cross PPO insurance.
    I thought the trial was somehow less expensive so it is not worth the money.

    Was it worth it? Yes

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