CPT code 67961: Eyelid repair, up to one-fourth of lid margin2026 Medicare rate & RVUs

Medicare pays $592.20 for 67961 nationally in the office and $390.46 in a hospital or facility. Local office rates run $530.19–$776.41.

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

What 67961 covers

An ophthalmologist, often an oculoplastic surgeon, reports this service when removing eyelid tissue requires excision through the margin and repair of the resulting defect. The excision may involve the tarsus and/or palpebral conjunctiva, and the affected portion must be no more than one-fourth of the lid margin. A typical setting is an operating room or ambulatory surgery center for removal of a lesion that requires this depth of excision and reconstruction.

Select the code based on the extent of lid margin removed, not just the lesion’s surface dimensions. The operative report should identify the eyelid and side, the proportion of the margin excised, involved tissue layers, and how the defect was repaired; the repair is part of this service. A 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are paid at 50%. For bilateral reporting with modifier 50, CMS pays 150%. Assistant-at-surgery payment requires documented medical necessity; 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 67961 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

67961 rates by state

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

How the 67961 rate is calculated

Each of 67961’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 67961

67961 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

67961 compared with similar codes

How to choose

67966Eyelid repairOver one-fourth lid margin

The determining distinction is the amount of lid margin excised: 67961 covers no more than one-fourth, while 67966 covers more than one-fourth.

67840Eyelid lesion excisionExcludes chalazion

67840 is for eyelid lesion excision without the full-thickness margin excision and repair represented by 67961.

67971Eyelid reconstructionUp to two-thirds, flap stage

67971 describes full-thickness reconstruction using a flap from the opposing eyelid; 67961 covers excision and repair of a limited margin defect.

Codes related to 67961

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