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CPT code 67904: Ptosis repair, external levator approach2026 Medicare rate & RVUs in Connecticut

Reports surgical correction of upper-eyelid ptosis through an external approach that resects or advances the levator mechanism to improve eyelid position.

CMS RVU26DEffective Oct 1, 2026One payment locality56.2K Medicare services in 2024

In Connecticut, Medicare pays $790.29 for 67904 in the office and $535.24 when it’s performed in a hospital or facility.

$790.29Office (non-facility)
$535.24Hospital or facility
+6.1%vs the national office rate ($744.84)

Check a contract rate as a % of Medicare · 67904 nationwide

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

We’ll open 67904 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 67904 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 67904 covers

This operation corrects upper-eyelid ptosis by reaching the levator mechanism through an external incision, typically in the eyelid crease, then shortening or advancing it to raise the lid. Ophthalmologists, including oculoplastic surgeons, perform it when the levator mechanism can be repaired and the eyelid droop warrants surgical correction. The surgeon assesses lid position and function and adjusts the repair to achieve appropriate eyelid height.

Report 67904 for the external levator approach, not a frontalis sling or an internal approach. The record should support the ptosis diagnosis, affected side, clinical findings and functional impact, and the operative method. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued is paid in full and others at 50%. Assistant-at-surgery payment is restricted; co-surgeons require supporting documentation, and team surgery is 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.

How Connecticut compares for 67904

Across 109 of 109 payment localities, the office rate for 67904 runs from $668.94 in Arkansas to $968.23 in San Benito County, CA. Connecticut pays $790.29. The RVUs are the same everywhere; the geographic indexes change the dollars.

67904 in Connecticut vs other payment areas
  1. Connecticut · this page$790.29
  2. Los Angeles, CA · California$833.03+$42.74
  3. Washington, DC area · District of Columbia$843.83+$53.54
  4. Miami, FL · Florida$797.04+$6.75
  5. Chicago, IL · Illinois$777.09−$13.20
  6. Manhattan, NY · New York$849.28+$58.99
  7. Alaska · Alaska$894.99+$104.70

Other areas in Connecticut first, then benchmark localities. Bars start at $0.

Every other payment area

67904 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$677.47$470.26
ArkansasArkansas$668.94$465.52
ArizonaArizona$727.34$497.87
Bakersfield, CACalifornia$785.79$526.24
Chico, CACalifornia$783.68$524.14
El Centro, CACalifornia$783.79$524.25
Fresno, CACalifornia$783.68$524.14
Hanford, CACalifornia$783.68$524.14

67904 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$668.94

$894.99

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
67904 office rate range by state
State / territoryOffice rate rangeLocalities
AK$894.991
AL$677.471
AR$668.941
AZ$727.341
CA$783.68–$968.2329
CO$772.871
CT$790.291
DC$843.831
DE$738.381
FL$735.36–$797.043
GA$698.94–$757.402
GU$799.211
HI$799.211
IA$692.341
ID$696.311
IL$716.73–$777.094
IN$699.841
KS$689.571
KY$691.531
LA$690.61–$720.442
MA$769.16–$843.032
MD$751.22–$843.833
ME$699.55–$732.662
MI$707.31–$743.512
MN$743.001
MO$680.30–$722.633
MS$674.731
MT$744.801
NC$705.941
ND$731.941
NE$695.641
NH$761.131
NJ$799.98–$836.842
NM$710.721
NV$741.681
NY$715.21–$867.685
OH$704.681
OK$690.391
OR$736.54–$794.892
PA$705.63–$772.712
PR$749.611
RI$762.731
SC$706.351
SD$730.421
TN$692.601
TX$701.57–$769.778
UT$714.811
VA$730.58–$843.832
VI$749.611
VT$729.481
WA$767.60–$859.082
WI$710.341
WV$693.471
WY$739.201

See 67904 in every payment locality

How the 67904 rate is calculated

Each of 67904’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 · 67904

RVUs × geographic indexes × conversion factor

Office or facility?

Work7.77

7.77 RVUs× 1.000 GPCI

Practice expense13.88

13.88 RVUs× 1.000 GPCI

Malpractice0.65

0.65 RVUs× 1.000 GPCI

Adjusted RVUs

22.3000

Conversion factor

$33.4009

Medicare rate

$744.84

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Connecticut inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,508

Code
67904
Physician work
7.77
Practice expense
13.88
Malpractice
0.65

GPCI2026.csv

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 67904 in Connecticut
ComponentRVULocality factorAdjusted
Physician work7.77× 1.0207.9254
Practice expense13.88× 1.07714.9488
Malpractice0.65× 1.2100.7865
Total RVUs23.6607
Conversion factor× 33.4009

Office rate, Connecticut$790.29

Office: (7.77 × 1.02 + 13.88 × 1.077 + 0.65 × 1.21) × $33.4009 = $790.29

Facility: (7.77 × 1.02 + 6.79 × 1.077 + 0.65 × 1.21) × $33.4009 = $535.24

Open 67904 in the RVU calculator

Payment rules and modifiers for 67904

67904 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 67904

Ptosis repair, external levator approach

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.70/0.20Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 67904

Ptosis repair, external levator approach

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

67904 without 50 · national office

$744.84

Ptosis repair, external levator approach

67904-50 · Bilateral: 150%

$1,117.26

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).

When to use modifier 50

Codes related to 67904

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

Codes related to 67904
CodeHow it relatesOffice range, Connecticut
Same family
67901Ptosis repair, frontalis sling, nonautologous materialPtosis repair using a frontalis technique with suture or other material.$843.38
67902Ptosis repair, frontalis sling with fasciaPtosis repair using a frontalis technique with an autologous fascial sling.No office rate
67903Ptosis repair, internal approachPtosis repair performed through an internal approach.$643.04

How 67904 has changed in Connecticut

67904 · Office / nonfacility

$790.29

Effective 2026-10-01

The base rate is $31.69 higher than on 2025-10-01, moving from $758.60 to $790.29 (4.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $758.60changed to$790.29

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 7.97 changed to 7.77
    • Practice expense RVU 13.30 changed to 13.88
    • Malpractice RVU 0.66 changed to 0.65
    • Work GPCI 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $787.64changed to$758.60

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 13.47 changed to 13.30
    • Malpractice RVU 0.68 changed to 0.66

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $774.79changed to$787.64

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $801.40changed to$774.79

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 13.37 changed to 13.47
    • Malpractice RVU 0.66 changed to 0.68
    • Work GPCI 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $814.30changed to$801.40

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 13.15 changed to 13.37
    • Work GPCI 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $822.34changed to$814.30

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 13.20 changed to 13.15
    • Malpractice RVU 0.64 changed to 0.66

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $815.72changed to$822.34

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 12.32 changed to 13.20
    • Malpractice RVU 0.63 changed to 0.64
    • Work GPCI 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $816.29changed to$815.72

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 12.34 changed to 12.32
    • Work GPCI 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $813.39changed to$816.29

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 12.29 changed to 12.34

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $806.20changed to$813.39

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 12.11 changed to 12.29
    • Work GPCI 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $804.85changed to$806.20

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 12.08 changed to 12.11
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $807.35changed to$804.85

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 12.07 changed to 12.08

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $803.33changed to$807.35

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $838.20changed to$803.33

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 12.05 changed to 12.07
    • Malpractice RVU 1.45 changed to 0.63
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $840.42changed to$838.20

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 13.21 changed to 12.05
    • Malpractice RVU 1.52 changed to 1.45
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $840.42

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$790.29$535.24RVU26D
2026-07-01$790.29$535.24RVU26C
2026-04-01$790.29$535.24RVU26B
2026-01-01$790.29$535.24RVU26A
2025-10-01$758.60$609.32RVU25D
2025-07-01$758.60$609.32RVU25C
2025-04-01$758.60$609.32RVU25B
2025-01-01$758.60$609.32RVU25A
2024-10-01$787.64$626.76RVU24D
2024-07-01$787.64$626.76RVU24C
2024-04-01$787.64$626.76RVU24B
2024-03-09$787.64$626.76RVU24AR
2024-01-01$774.79$616.53RVU24A
2023-10-01$801.40$633.35RVU23D
2023-07-01$801.40$633.35RVU23C
2023-04-01$801.40$633.35RVU23B
2023-01-01$801.40$633.35RVU23A
2022-10-01$814.30$638.50RVU22D
2022-07-01$814.30$638.50RVU22C
2022-04-01$814.30$638.50RVU22B
2022-01-01$814.30$638.50RVU22A
2021-10-01$822.34$642.37RVU21D
2021-07-01$822.34$642.37RVU21C
2021-04-01$822.34$642.37RVU21B
2021-01-01$822.34$642.37RVU21A
2020-10-01$815.72$653.44RVU20D
2020-07-01$815.72$653.44RVU20C
2020-04-01$815.72$653.44RVU20B
2020-01-01$815.72$653.44RVU20A
2019-10-01$816.29$657.99RVU19D
2019-07-01$816.29$657.99RVU19C
2019-04-01$816.29$657.99RVU19B
2019-01-01$816.29$657.99RVU19A
2018-10-01$813.39$659.67RVU18D
2018-07-01$813.39$659.67RVU18C
2018-04-01$813.39$659.67RVU18B
2018-01-01$813.39$659.67RVU18AR1
2017-10-01$806.20$655.87RVU17D
2017-07-01$806.20$655.87RVU17C
2017-04-01$806.20$655.87RVU17B
2017-01-01$806.20$655.87RVU17A
2016-10-01$804.85$654.34RVU16D
2016-07-01$804.85$654.34RVU16C
2016-04-01$804.85$654.34RVU16B
2016-01-01$804.85$654.34RVU16A
2015-10-01$807.35$655.89RVU15D
2015-07-01$807.35$655.89RVU15C
2015-04-01$803.33$652.63RVU15B
2015-01-01$803.33$652.63RVU15A
2014-10-01$838.20$690.28RVU14D
2014-07-01$838.20$690.28RVU14C
2014-04-01$838.20$690.28RVU14B
2014-01-01$838.20$690.28RVU14A
2013-10-01$840.42$683.69RVU13D
2013-07-01$840.42$683.69RVU13C
2013-04-01$840.42$683.69RVU13B
2013-01-01$840.42$683.69RVU13AR

Price 67904 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

67904 billing questions

When should 67904 be selected instead of a frontalis sling code?

Use 67904 when the surgeon corrects ptosis by externally resecting or advancing the levator mechanism. Frontalis suspension codes describe a different operative technique.

How does 67904 differ from an internal ptosis repair?

67904 uses an external approach to the levator mechanism. Select an internal-approach code when the operative report documents correction through the inside of the eyelid.

Does the 90-day global period include routine postoperative visits?

Yes. Related postoperative care for 90 days and the preoperative visit on the day before surgery are included in the global period.

How is bilateral 67904 paid?

CMS pays bilateral surgery reported with modifier 50 at 150%.

Can an assistant or co-surgeon be reported for 67904?

Assistant-at-surgery payment is restricted. Co-surgeons are paid only with supporting documentation, and team surgery is not permitted.

What happens when 67904 is performed with another procedure in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

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
RVUs for 67904PPRRVU2026_Oct_nonQPP.csv, line 7,508 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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