Billing code 67906: Ptosis repairMedicare rate & RVUs in Maine
Surgical correction of upper eyelid ptosis using a superior rectus-based fascial sling, reported when the operative technique matches this specific repair.
CMS doesn’t publish an office rate for 67906 in Maine.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 67906 covers
billing code 67906 reports surgical correction of blepharoptosis using a superior rectus-based technique with a fascial sling to elevate the upper eyelid. An ophthalmologist, commonly an oculoplastic surgeon, performs this operation when the selected repair uses this specific muscle-and-sling approach. The code is selected by the technique documented, not simply because ptosis is severe or congenital.
The operative report should identify the affected eyelid, describe the superior rectus and sling technique, and support the medical need for repair. This major surgery has 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 are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment is restricted; 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 67906 pays more and less in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Maine | Unavailable | $406.12 |
| Southern Maine | Unavailable | $419.34 |
How the 67906 rate is calculated
Each of 67906’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 · 67906
RVUs × geographic indexes × conversion factor
Work6.76
6.76 RVUs× 1.000 GPCI
Practice expense5.51
5.51 RVUs× 1.000 GPCI
Malpractice0.53
0.53 RVUs× 1.000 GPCI
Adjusted RVUs
12.8000
Conversion factor
$33.4009
Medicare rate
$427.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 67906
67906 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 67906
Ptosis repair
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 67906
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
67906 without 50 · national facility
$427.53
Ptosis repair
67906-50 · Bilateral: 150%
$641.30
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).
67906 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 67901Ptosis repair
- Use 67901 for a frontalis muscle technique with suture or other material. Use 67906 when the operative method is a superior rectus-based fascial sling.
- 67902Ptosis repair
- 67902 describes frontalis suspension using an autologous fascial sling; 67906 identifies the superior rectus-based sling approach.
- 67903Ptosis repair
- 67903 is an internal ptosis repair approach. 67906 is selected for the superior rectus-based fascial sling technique.
- 67904Ptosis repair
- 67904 is an external levator-based ptosis repair. 67906 applies when the surgeon uses the superior rectus and a fascial sling.
67906 billing questions
How is 67906 distinguished from other ptosis repairs?
Choose 67906 when the operative report documents the superior rectus-based fascial sling technique. Frontalis suspension or levator-based repairs belong to different codes.
What documentation supports reporting 67906?
Document the ptosis, the eyelid treated, the medical reason for repair, and the superior rectus-and-sling technique performed.
Does the 90-day global period include postoperative visits?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included.
How is bilateral 67906 handled?
For a bilateral procedure, report modifier 50; CMS pays the procedure at 150%.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is restricted for this code. Co-surgeons and team surgery are not permitted.
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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