CPT code 15823: Upper eyelid surgery, excess skin affects lid function2026 Medicare rate & RVUs

Medicare pays $632.95 for 15823 nationally in the office and $481.64 in a hospital or facility. Local office rates run $568.31–$821.53.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 15823 covers

This procedure removes excess upper eyelid skin that hangs over or weighs down the lid. Ophthalmologists, oculoplastic surgeons, and plastic surgeons commonly perform it for patients with functional concerns such as restricted superior vision from drooping eyelid skin. It may be performed in an office-based surgical setting or an operating room, depending on the case and setting.

Choose this code when the record supports excess upper-lid skin affecting function, rather than an upper eyelid procedure without that feature. Document the eyelid findings and the functional impact; examination findings and visual-field information may support medical necessity. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 15823 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

15823 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 15823 rate is calculated

Each of 15823’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 15823

15823 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

15823 compared with similar codes

How to choose

15822Upper eyelid surgeryWithout lid-weighting excess skin

Choose 15823 when excess upper-lid skin weighs down the lid; 15822 is the upper eyelid sibling without that distinguishing feature.

15820Lower eyelid surgeryLower eyelid

15820 is for lower eyelid surgery. Use 15823 for the upper eyelid when excess skin affects lid function.

15821Lower eyelid surgeryProminent fat-pad prolapse

15821 concerns lower eyelid surgery involving a prominent fat pad; 15823 addresses functionally significant excess skin of the upper eyelid.

Codes related to 15823

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates