CPT code 67961: Eyelid repair, up to one-fourth of lid margin2026 Medicare rate & RVUs in California
Reports excision and repair of an eyelid defect involving the lid margin and deeper eyelid structures when the excision spans no more than one-fourth of the margin.
Medicare pays $625.19–$776.41 for 67961 in the office in California, from Chico, CA to San Benito County, CA. 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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On this page 9 sections
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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$625.19 to $776.41
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $626.72 | $405.61 |
| Chico, CA | $625.19 | $404.08 |
| El Centro, CA | $625.27 | $404.16 |
| Fresno, CA | $625.19 | $404.08 |
| Hanford, CA | $625.19 | $404.08 |
| Los Angeles, CA | $665.34 | $426.68 |
| Madera, CA | $625.19 | $404.08 |
| Marin County, CA | $759.99 | $475.54 |
| Merced, CA | $625.19 | $404.08 |
| Modesto, CA | $625.19 | $404.08 |
| Napa, CA | $719.17 | $453.27 |
| Oxnard, CA | $661.83 | $423.37 |
| Redding, CA | $625.19 | $404.08 |
| Rest of California | $625.19 | $404.08 |
| Riverside, CA | $630.36 | $409.25 |
| Sacramento, CA | $654.66 | $420.04 |
| Salinas, CA | $652.17 | $418.35 |
| San Benito County, CA | $776.41 | $485.50 |
| San Diego, CA | $666.34 | $425.06 |
| San Francisco, CA | $759.46 | $475.00 |
| San Luis Obispo, CA | $641.78 | $412.00 |
| Santa Clara County, CA | $774.23 | $483.31 |
| Santa Cruz, CA | $671.86 | $426.75 |
| Santa Maria, CA | $654.29 | $419.06 |
| Santa Rosa, CA | $678.59 | $430.85 |
| Stockton, CA | $625.19 | $404.08 |
| Vallejo, CA | $718.40 | $452.50 |
| Visalia, CA | $625.19 | $404.08 |
| Yuba City, CA | $625.19 | $404.08 |
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.
How the rate is built · 67961
RVUs × geographic indexes × conversion factor
Work5.71
5.71 RVUs× 1.000 GPCI
Practice expense11.55
11.55 RVUs× 1.000 GPCI
Malpractice0.47
0.47 RVUs× 1.000 GPCI
Adjusted RVUs
17.7300
Conversion factor
$33.4009
Medicare rate
$592.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 67961
67961 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 67961
Eyelid repair, up to one-fourth of lid margin
| 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) | 0 | Not paid without supporting documentation. |
| 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) | 0.10/0.70/0.20 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 67961
Eyelid repair, up to one-fourth of lid margin
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
67961 without 50 · national office
$592.20
Eyelid repair, up to one-fourth of lid margin
67961-50 · Bilateral: 150%
$888.30
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).
67961 compared with similar codes
Compare codes · National
4 codes, side by side
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.
67961 billing questions
When should 67961 be chosen instead of 67966?
Use 67961 when the excision involves no more than one-fourth of the lid margin. Use 67966 when it involves more than one-fourth.
Can the eyelid repair be billed separately?
The repair of the defect created by the excision is included in 67961. The operative report should describe the repair performed.
What documentation supports 67961?
Document the eyelid and laterality, the proportion of lid margin removed, the involved structures, and the method used to repair the defect.
How is bilateral 67961 reported?
Report the bilateral procedure with modifier 50. CMS pays bilateral procedures with modifier 50 at 150%.
Can an assistant surgeon be paid for 67961?
Assistant-at-surgery payment is available only when medical necessity is documented. CMS does not permit co-surgeons or team surgery for this code.
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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