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

In South Dakota, Medicare pays $730.42 for 67904 in the office and $493.61 when it’s performed in a hospital or facility.

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.

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 South Dakota 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. South Dakota pays $730.42. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

67904 rates by state

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

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.

Payment rules and modifiers for 67904

67904 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

Codes related to 67904

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

How 67904 has changed in South Dakota

Price 67904 for an earlier date of service

Where the South Dakota rate applies

South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.

• Aberdeen
• Agar
• Agency Village
• Akaska
• Albee
• Alcester
• Alexandria
• Allen

Browse all communities in South Dakota

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