67971 Eyelid reconstruction Medicare reimbursement rates in New Mexico

This procedure rebuilds a full-thickness eyelid defect by transferring a tarsoconjunctival flap from the opposing eyelid. It is commonly used for substantial lower-eyelid defects, such as after removal of an eyelid tumor, when local tissue alone cannot restore the lid. An ophthalmologist with oculoplastic expertise typically performs the surgery in an operating room. The code covers a one-stage reconstruction or the first stage of a staged repair; the flap is generally taken from the upper eyelid to reconstruct the lower lid.

Select this code when the defect involves up to two-thirds of the eyelid and the operative method uses the opposing-lid flap. Document the defect’s extent, the donor eyelid, the flap transfer, and whether this is the first or only stage. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; co-surgeons require supporting documentation, and team surgery is not permitted.