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

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.

CMS RVU26DEffective Oct 1, 2026One payment locality5.3K Medicare services in 2024

In Puerto Rico, Medicare pays $596.21 for 67961 in the office and $392.25 when it’s performed in a hospital or facility.

$596.21Office (non-facility)
$392.25Hospital or facility
+0.7%vs the national office rate ($592.20)

Check a contract rate as a % of Medicare · 67961 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 67961 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 67961 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 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.

How Puerto Rico compares for 67961

Across 109 of 109 payment localities, the office rate for 67961 runs from $530.19 in Arkansas to $776.41 in San Benito County, CA. Puerto Rico pays $596.21. The RVUs are the same everywhere; the geographic indexes change the dollars.

67961 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$596.21
  2. Los Angeles, CA · California$665.34+$69.13
  3. Washington, DC area · District of Columbia$672.94+$76.73
  4. Miami, FL · Florida$632.02+$35.81
  5. Chicago, IL · Illinois$615.79+$19.58
  6. Manhattan, NY · New York$676.10+$79.89
  7. Alaska · Alaska$705.58+$109.37

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

Every other payment area

67961 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$537.16$360.64
ArkansasArkansas$530.19$356.89
ArizonaArizona$577.98$382.49
Bakersfield, CACalifornia$626.72$405.61
Chico, CACalifornia$625.19$404.08
El Centro, CACalifornia$625.27$404.16
Fresno, CACalifornia$625.19$404.08
Hanford, CACalifornia$625.19$404.08

67961 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.

$530.19

$705.58

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

View every state and territory as a table
67961 office rate range by state
State / territoryOffice rate rangeLocalities
AK$705.581
AL$537.161
AR$530.191
AZ$577.981
CA$625.19–$776.4129
CO$615.741
CT$629.011
DC$672.941
DE$586.941
FL$583.12–$632.023
GA$553.55–$602.102
GU$638.441
HI$638.441
IA$549.941
ID$553.061
IL$567.47–$616.074
IN$555.971
KS$547.381
KY$548.041
LA$547.17–$571.572
MA$612.51–$673.132
MD$597.45–$672.943
ME$555.40–$582.932
MI$560.66–$589.462
MN$592.331
MO$538.55–$573.713
MS$534.481
MT$592.171
NC$560.681
ND$582.871
NE$552.731
NH$606.051
NJ$636.84–$667.012
NM$563.331
NV$589.961
NY$568.25–$690.775
OH$558.761
OK$547.421
OR$585.99–$634.052
PA$559.70–$614.482
PR$596.211
RI$606.861
SC$560.521
SD$581.771
TN$549.821
TX$556.36–$613.178
UT$567.451
VA$581.02–$672.942
VI$596.211
VT$580.591
WA$611.37–$686.432
WI$565.131
WV$548.431
WY$588.121

See 67961 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,526

Code
67961
Physician work
5.71
Practice expense
11.55
Malpractice
0.47

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 67961 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work5.71× 1.0005.7100
Practice expense11.55× 1.01111.6770
Malpractice0.47× 0.9850.4629
Total RVUs17.8500
Conversion factor× 33.4009

Office rate, Puerto Rico$596.21

Office: (5.71 × 1 + 11.55 × 1.011 + 0.47 × 0.985) × $33.4009 = $596.21

Facility: (5.71 × 1 + 5.51 × 1.011 + 0.47 × 0.985) × $33.4009 = $392.25

Open 67961 in the RVU calculator

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

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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
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 · 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.

  • 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

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).

When to use modifier 50

Codes related to 67961

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

Codes related to 67961
CodeHow it relatesOffice range, Puerto Rico
Same family
67966Eyelid repair, over one-fourth lid marginRelated eyelid excision and repair when more than one-fourth of the lid margin is involved.$787.34
Used instead
67840Eyelid lesion excision, excludes chalazionFor eyelid lesion excision without the full-thickness margin reconstruction described by 67961.$280.06
67971Eyelid reconstruction, up to two-thirds, flap stageA flap-based option for full-thickness eyelid reconstruction when the defect calls for that technique.No office rate

How 67961 has changed in Puerto Rico

67961 · Office / nonfacility

$596.21

Effective 2026-10-01

The base rate is $28.57 higher than on 2025-10-01, moving from $567.64 to $596.21 (5.0%).

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

    $567.64changed to$596.21

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.86 changed to 5.71
    • Practice expense RVU 11.12 changed to 11.55
    • Malpractice RVU 0.50 changed to 0.47
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $588.20changed to$567.64

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 11.26 changed to 11.12
    • Malpractice RVU 0.48 changed to 0.50

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $578.60changed to$588.20

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $595.12changed to$578.60

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 11.16 changed to 11.26
    • Malpractice RVU 0.46 changed to 0.48
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $592.35changed to$595.12

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $601.50changed to$592.35

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.97 changed to 11.16
    • Malpractice RVU 0.47 changed to 0.46
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $606.49changed to$601.50

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.98 changed to 10.97
    • Malpractice RVU 0.46 changed to 0.47

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $597.85changed to$606.49

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 10.16 changed to 10.98
    • Malpractice RVU 0.47 changed to 0.46
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $595.96changed to$597.85

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.45 changed to 0.47
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $593.13changed to$595.96

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 10.09 changed to 10.16
    • Malpractice RVU 0.46 changed to 0.45

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $525.73changed to$593.13

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.93 changed to 10.09
    • Malpractice RVU 0.45 changed to 0.46
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $464.68changed to$525.73

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.91 changed to 9.93
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $466.46changed to$464.68

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.46 changed to 0.45

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $464.14changed to$466.46

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $465.03changed to$464.14

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.88 changed to 9.91
    • Malpractice RVU 1.05 changed to 0.46
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $458.98changed to$465.03

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 10.85 changed to 9.88
    • Malpractice RVU 1.10 changed to 1.05
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $458.98

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$596.21$392.25RVU26D
2026-07-01$596.21$392.25RVU26C
2026-04-01$596.21$392.25RVU26B
2026-01-01$596.21$392.25RVU26A
2025-10-01$567.64$439.31RVU25D
2025-07-01$567.64$439.31RVU25C
2025-04-01$567.64$439.31RVU25B
2025-01-01$567.64$439.31RVU25A
2024-10-01$588.20$450.76RVU24D
2024-07-01$588.20$450.76RVU24C
2024-04-01$588.20$450.76RVU24B
2024-03-09$588.20$450.76RVU24AR
2024-01-01$578.60$443.40RVU24A
2023-10-01$595.12$453.71RVU23D
2023-07-01$592.35$452.06RVU23C
2023-04-01$592.35$452.06RVU23B
2023-01-01$592.35$452.06RVU23A
2022-10-01$601.50$455.69RVU22D
2022-07-01$601.50$455.69RVU22C
2022-04-01$601.50$455.69RVU22B
2022-01-01$601.50$455.69RVU22A
2021-10-01$606.49$458.42RVU21D
2021-07-01$606.49$458.42RVU21C
2021-04-01$606.49$458.42RVU21B
2021-01-01$606.49$458.42RVU21A
2020-10-01$597.85$465.79RVU20D
2020-07-01$597.85$465.79RVU20C
2020-04-01$597.85$465.79RVU20B
2020-01-01$597.85$465.79RVU20A
2019-10-01$595.96$467.49RVU19D
2019-07-01$595.96$467.49RVU19C
2019-04-01$595.96$467.49RVU19B
2019-01-01$595.96$467.49RVU19A
2018-10-01$593.13$469.15RVU18D
2018-07-01$593.13$469.15RVU18C
2018-04-01$593.13$469.15RVU18B
2018-01-01$593.13$469.15RVU18AR1
2017-10-01$525.73$423.43RVU17D
2017-07-01$525.73$423.43RVU17C
2017-04-01$525.73$423.43RVU17B
2017-01-01$525.73$423.43RVU17A
2016-10-01$464.68$380.63RVU16D
2016-07-01$464.68$380.63RVU16C
2016-04-01$464.68$380.63RVU16B
2016-01-01$464.68$380.63RVU16A
2015-10-01$466.46$381.60RVU15D
2015-07-01$466.46$381.60RVU15C
2015-04-01$464.14$379.70RVU15B
2015-01-01$464.14$379.70RVU15A
2014-10-01$465.03$383.23RVU14D
2014-07-01$465.03$383.23RVU14C
2014-04-01$465.03$383.23RVU14B
2014-01-01$465.03$383.23RVU14A
2013-10-01$458.98$373.63RVU13D
2013-07-01$458.98$373.63RVU13C
2013-04-01$458.98$373.63RVU13B
2013-01-01$458.98$373.63RVU13AR

Price 67961 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 67961PPRRVU2026_Oct_nonQPP.csv, line 7,526 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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