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CPT code 67904: Ptosis repair2026 Medicare rate & RVUs in Delaware

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 Delaware, Medicare pays $738.38 for 67904 in the office and $504.41 when it’s performed in a hospital or facility.

$738.38Office (non-facility)
$504.41Hospital or facility
−0.9%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 Delaware
  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 Delaware 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 Jose-Sunnyvale-Santa Clara (San Benito Cnty). Delaware pays $738.38. The RVUs are the same everywhere; the geographic indexes change the dollars.

67904 in Delaware vs other payment areas
  1. Delaware · this page$738.38
  2. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) · California$833.03+$94.65
  3. Dc + Md/Va Suburbs · District of Columbia$843.83+$105.45
  4. Miami · Florida$797.04+$58.66
  5. Chicago · Illinois$777.09+$38.71
  6. Manhattan · New York$849.28+$110.90
  7. Alaska* · Alaska$894.99+$156.61

Other areas in Delaware 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
BakersfieldCalifornia$785.79$526.24
ChicoCalifornia$783.68$524.14
El CentroCalifornia$783.79$524.25
FresnoCalifornia$783.68$524.14
Hanford-CorcoranCalifornia$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

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 Delaware 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

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 67904 in Delaware
ComponentRVULocality factorAdjusted
Physician work7.77× 1.0057.8088
Practice expense13.88× 0.98813.7134
Malpractice0.65× 0.8990.5844
Total RVUs22.1066
Conversion factor× 33.4009

Office rate, Delaware$738.38

Office: (7.77 × 1.005 + 13.88 × 0.988 + 0.65 × 0.899) × $33.4009 = $738.38

Facility: (7.77 × 1.005 + 6.79 × 0.988 + 0.65 × 0.899) × $33.4009 = $504.41

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

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

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

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, Delaware
Same family
67901Ptosis repairPtosis repair using a frontalis technique with suture or other material.$786.44
67902Ptosis repairPtosis repair using a frontalis technique with an autologous fascial sling.No office rate
67903Ptosis repairPtosis repair performed through an internal approach.$601.07

How 67904 has changed in Delaware

67904 · Office / nonfacility

$738.38

Effective 2026-10-01

The base rate is $31.23 higher than on 2025-10-01, moving from $707.15 to $738.38 (4.4%).

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

    $707.15changed to$738.38

    • 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 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $733.97changed to$707.15

    • 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

    $721.99changed to$733.97

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $749.19changed to$721.99

    • 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 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $763.45changed to$749.19

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 13.15 changed to 13.37
    • Work GPCI 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $770.91changed to$763.45

    • 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

    $766.58changed to$770.91

    • 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 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $767.82changed to$766.58

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 12.34 changed to 12.32
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $765.15changed to$767.82

    • 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

    $759.26changed to$765.15

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 12.11 changed to 12.29
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $759.14changed to$759.26

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 12.08 changed to 12.11
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $761.51changed to$759.14

    • 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

    $757.72changed to$761.51

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $782.61changed to$757.72

    • 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 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $778.39changed to$782.61

    • 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 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $778.39

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$738.38$504.41RVU26D
2026-07-01$738.38$504.41RVU26C
2026-04-01$738.38$504.41RVU26B
2026-01-01$738.38$504.41RVU26A
2025-10-01$707.15$571.42RVU25D
2025-07-01$707.15$571.42RVU25C
2025-04-01$707.15$571.42RVU25B
2025-01-01$707.15$571.42RVU25A
2024-10-01$733.97$587.68RVU24D
2024-07-01$733.97$587.68RVU24C
2024-04-01$733.97$587.68RVU24B
2024-03-09$733.97$587.68RVU24AR
2024-01-01$721.99$578.09RVU24A
2023-10-01$749.19$595.63RVU23D
2023-07-01$749.19$595.63RVU23C
2023-04-01$749.19$595.63RVU23B
2023-01-01$749.19$595.63RVU23A
2022-10-01$763.45$602.17RVU22D
2022-07-01$763.45$602.17RVU22C
2022-04-01$763.45$602.17RVU22B
2022-01-01$763.45$602.17RVU22A
2021-10-01$770.91$605.80RVU21D
2021-07-01$770.91$605.80RVU21C
2021-04-01$770.91$605.80RVU21B
2021-01-01$770.91$605.80RVU21A
2020-10-01$766.58$617.72RVU20D
2020-07-01$766.58$617.72RVU20C
2020-04-01$766.58$617.72RVU20B
2020-01-01$766.58$617.72RVU20A
2019-10-01$767.82$622.76RVU19D
2019-07-01$767.82$622.76RVU19C
2019-04-01$767.82$622.76RVU19B
2019-01-01$767.82$622.76RVU19A
2018-10-01$765.15$624.28RVU18D
2018-07-01$765.15$624.28RVU18C
2018-04-01$765.15$624.28RVU18B
2018-01-01$765.15$624.28RVU18AR1
2017-10-01$759.26$621.32RVU17D
2017-07-01$759.26$621.32RVU17C
2017-04-01$759.26$621.32RVU17B
2017-01-01$759.26$621.32RVU17A
2016-10-01$759.14$620.71RVU16D
2016-07-01$759.14$620.71RVU16C
2016-04-01$759.14$620.71RVU16B
2016-01-01$759.14$620.71RVU16A
2015-10-01$761.51$622.21RVU15D
2015-07-01$761.51$622.21RVU15C
2015-04-01$757.72$619.11RVU15B
2015-01-01$757.72$619.11RVU15A
2014-10-01$782.61$645.03RVU14D
2014-07-01$782.61$645.03RVU14C
2014-04-01$782.61$645.03RVU14B
2014-01-01$782.61$645.03RVU14A
2013-10-01$778.39$630.98RVU13D
2013-07-01$778.39$630.98RVU13C
2013-04-01$778.39$630.98RVU13B
2013-01-01$778.39$630.98RVU13AR

Price 67904 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Delaware

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 DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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