CPT code 67904: Ptosis repair2026 Medicare rate & RVUs in New Jersey
Reports surgical correction of upper-eyelid ptosis through an external approach that resects or advances the levator mechanism to improve eyelid position.
Medicare pays $799.98–$836.84 for 67904 in the office in New Jersey, from Rest Of New Jersey to Northern Nj. 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.
On this page 9 sections
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.
Where 67904 pays more and less in New Jersey
| Payment locality | Office | Facility |
|---|---|---|
| Northern Nj | $836.84 | $562.14 |
| Rest Of New Jersey | $799.98 | $541.38 |
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.
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
| 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) | 1 | Permitted with supporting documentation. |
| 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 · 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.
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).
67904 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 67901Ptosis repair
- 67901 describes frontalis suspension using suture or other material. Choose 67904 when the operative method is external levator resection or advancement.
- 67902Ptosis repair
- 67902 uses an autologous fascial sling with a frontalis technique. 67904 repairs ptosis through the levator mechanism using an external approach.
- 67903Ptosis repair
- 67903 is an internal-approach ptosis repair; 67904 is selected for an external levator approach.
- 67900Brow repair
- 67900 corrects a brow defect, while 67904 corrects upper-eyelid ptosis through the levator mechanism.
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
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