CPT code 15823: Upper eyelid surgery, excess skin affects lid function2026 Medicare rate & RVUs in Missouri
Reports upper eyelid surgery to remove excess skin that weighs down the lid, typically when documented functional impairment supports the procedure.
Medicare pays $578.38–$614.18 for 15823 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$578.38 to $614.18
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $608.60 | $466.53 |
| Metropolitan St. Louis, MO | $614.18 | $470.14 |
| Rest of Missouri | $578.38 | $447.95 |
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.
How the rate is built · 15823
RVUs × geographic indexes × conversion factor
Work6.64
6.64 RVUs× 1.000 GPCI
Practice expense11.73
11.73 RVUs× 1.000 GPCI
Malpractice0.58
0.58 RVUs× 1.000 GPCI
Adjusted RVUs
18.9500
Conversion factor
$33.4009
Medicare rate
$632.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 15823
15823 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 15823
Upper eyelid surgery, excess skin affects lid function
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 15823
Upper eyelid surgery, excess skin affects lid function
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
15823 without 50 · national office
$632.95
Upper eyelid surgery, excess skin affects lid function
15823-50 · Bilateral: 150%
$949.43
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
15823 compared with similar codes
Compare codes · National
4 codes, side by side
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.
15823 billing questions
How does this differ from 15822?
Use 15823 when excess upper-lid skin weighs down the lid. Code 15822 describes upper eyelid surgery without that distinguishing feature.
What documentation supports reporting 15823?
Document the excess upper-lid skin, the effect on eyelid function, and relevant clinical findings. Visual-field information may help show the functional impact.
Can 15823 be reported with lower eyelid surgery?
It may be reported with a separately performed lower eyelid procedure when both services are supported. The multiple procedure reduction applies when procedures are performed in the same session.
How is bilateral 15823 reported?
Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.
Are an assistant surgeon or co-surgeon payable?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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
Show the CMS file lines behind this rate
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