$549.94
The key distinction is the amount of lid margin excised: 67961 applies to up to one-fourth, while 67966 applies to more than one-fourth.
On this page
CMS RVU26D · Effective 2026-10-01
67966 Eyelid repair Medicare reimbursement rates in Iowa
Report 67966 when excision and repair involve a full-thickness eyelid segment extending over one-fourth of the lid margin. Compare 67966 office and facility rates across CMS payment localities in Iowa.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 67966 in Iowa?
Iowa has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$728.28
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$519.84
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Ophthalmic surgery
About 67966: Extensive full-thickness eyelid excision and repair
Report 67966 when excision and repair involve a full-thickness eyelid segment extending over one-fourth of the lid margin.
An ophthalmic or oculoplastic surgeon uses this service to remove and repair a substantial eyelid segment involving the lid margin and deeper structures, such as the tarsus and conjunctiva. A typical setting is an operating room or ambulatory surgery center, including treatment of a lesion or tumor that leaves a large full-thickness defect. The defining extent is more than one-fourth of the horizontal lid margin; this is not a code for a skin-only removal or a small defect.
The operative report should identify the affected eyelid, structures involved, amount of lid margin excised, and how the resulting defect was repaired. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. For bilateral reporting with modifier 50, CMS pays at 150%. CMS does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 67966
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.75 · 37%
- Practice expense (office) RVU13.95 · 60%
- Malpractice RVU0.73 · 3%
7.7K
Medicare services in 2024 · #1610 by national volume
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.
67966 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
67971 describes eyelid reconstruction for a full-thickness defect under its own criteria; 67966 describes excision and repair of a segment extending over one-fourth of the lid margin.
$546.73
67950 is canthoplasty. It is not the code for excision and repair of a full-thickness eyelid segment over one-fourth of the lid margin.
Compare 67966 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Iowa →
Office / nonfacility
$728.28
Facility
$519.84
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 67966 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
7,527
- Code
- 67966
- Physician work
- 8.75
- Practice expense
- 13.95
- Malpractice
- 0.73
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.75 | × 1.000 | 8.7500 |
| Practice expense | 13.95 | × 0.915 | 12.7643 |
| Malpractice | 0.73 | × 0.397 | 0.2898 |
| Total RVUs | 21.8041 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$728.28
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.75 | 1 |
| Practice expense | 13.95 | 0.915 |
| Malpractice | 0.73 | 0.397 |
(8.75 × 1 + 13.95 × 0.915 + 0.73 × 0.397) × $33.4009 = $728.28
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.75 | 1 |
| Practice expense | 7.13 | 0.915 |
| Malpractice | 0.73 | 0.397 |
(8.75 × 1 + 7.13 × 0.915 + 0.73 × 0.397) × $33.4009 = $519.84
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
67966 billing questions
How is 67966 distinguished from 67961?
Both describe eyelid excision and repair involving deeper structures. Use 67966 when the excised lid-margin segment is over one-fourth of the horizontal length; 67961 is for up to one-fourth.
What documentation supports 67966?
Document the eyelid and structures involved, the extent of the excision in relation to the horizontal lid margin, and the repair performed. The record should support that the segment exceeded one-fourth of the margin.
Does the 90-day global period include postoperative visits?
Related postoperative care during the 90-day period is included, as is the day-before preoperative visit.
How does Medicare handle bilateral reporting?
For bilateral procedures reported with modifier 50, CMS pays at 150%.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for 67966. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,52467938,,Remove eyelid foreign body,A,,1.35,6.14,,1.59,,0.06,7.55,3.00,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,52567950,,Revision of eyelid,A,,5.84,11.29,,5.56,,0.50,17.63,11.90,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,52667961,,Revision of eyelid,A,,5.71,11.55,,5.51,,0.47,17.73,11.69,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,52767966,,Revision of eyelid,A,,8.75,13.95,,7.13,,0.73,23.43,16.61,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,52867971,,Reconstruction of eyelid,A,,9.76,7.62,NA,7.62,,0.81,18.19,18.19,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,52967973,,Reconstruction of eyelid,A,,12.80,9.39,NA,9.39,,1.07,23.26,23.26,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53067974,,Reconstruction of eyelid,A,,12.77,9.38,NA,9.38,,1.06,23.21,23.21,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136