$733.66
67901 describes frontalis suspension using suture or other material. Choose 67904 when the operative method is external levator resection or advancement.
On this page
CMS RVU26D · Effective 2026-10-01
67904 Ptosis repair Medicare reimbursement rates in West Virginia
Reports surgical correction of upper-eyelid ptosis through an external approach that resects or advances the levator mechanism to improve eyelid position. Compare 67904 office and facility rates across CMS payment localities in West Virginia.
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 67904 in West Virginia?
West Virginia 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
$693.47
1 of 1 localities have a supported rate.
Payment area: West Virginia
One mapped payment locality.
Facility setting
$487.68
1 of 1 localities have a supported rate.
Payment area: West Virginia
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.
Oculoplastic surgery
About 67904: External levator advancement for ptosis
Reports surgical correction of upper-eyelid ptosis through an external approach that resects or advances the levator mechanism to improve eyelid position.
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.
CMS billing rules for 67904
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.77 · 35%
- Practice expense (office) RVU13.88 · 62%
- Malpractice RVU0.65 · 3%
56.2K
Medicare services in 2024 · #740 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.
67904 compared with similar codes
Office rates for West Virginia, from the same CMS release.
No office rate
67902 uses an autologous fascial sling with a frontalis technique. 67904 repairs ptosis through the levator mechanism using an external approach.
$563.98
67903 is an internal-approach ptosis repair; 67904 is selected for an external levator approach.
$611.87
67900 corrects a brow defect, while 67904 corrects upper-eyelid ptosis through the levator mechanism.
Compare 67904 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
West Virginia →
Office / nonfacility
$693.47
Facility
$487.68
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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 67904 in West Virginia.
PPRRVU2026_Oct_nonQPP.csv
7,508
- Code
- 67904
- Physician work
- 7.77
- Practice expense
- 13.88
- Malpractice
- 0.65
GPCI2026.csv
110
- Locality
- West Virginia
- Physician work
- 1.000
- Practice expense
- 0.869
- Malpractice
- 1.431
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.77 | × 1.000 | 7.7700 |
| Practice expense | 13.88 | × 0.869 | 12.0617 |
| Malpractice | 0.65 | × 1.431 | 0.9302 |
| Total RVUs | 20.7619 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, West Virginia$693.47
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.77 | 1 |
| Practice expense | 13.88 | 0.869 |
| Malpractice | 0.65 | 1.431 |
(7.77 × 1 + 13.88 × 0.869 + 0.65 × 1.431) × $33.4009 = $693.47
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.77 | 1 |
| Practice expense | 6.79 | 0.869 |
| Malpractice | 0.65 | 1.431 |
(7.77 × 1 + 6.79 × 0.869 + 0.65 × 1.431) × $33.4009 = $487.68
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.
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 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.
7,50567901,,Repair eyelid defect,A,,7.40,15.74,,7.02,,0.62,23.76,15.04,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,50667902,,Repair eyelid defect,A,,9.57,8.07,NA,8.07,,0.78,18.42,18.42,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,50767903,,Repair eyelid defect,A,,6.35,11.30,,5.38,,0.50,18.15,12.23,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,50867904,,Repair eyelid defect,A,,7.77,13.88,,6.79,,0.65,22.30,15.21,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,50967906,,Repair eyelid defect,A,,6.76,5.51,NA,5.51,,0.53,12.80,12.80,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,51067908,,Repair eyelid defect,A,,5.17,10.77,,5.64,,0.42,16.36,11.23,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,51167909,,Revise eyelid defect,A,,5.43,10.65,,5.43,,0.48,16.56,11.34,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,