2025 CPT code 67901
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Repair of blepharoptosis using the frontalis muscle technique with suture or other material (e.g., banked fascia).
Modifiers E1-E4 (for the four eyelids) and other applicable modifiers (e.g., 50 for bilateral procedures, 22 for increased procedural services, 59 for distinct procedural services) may be used as appropriate.
Medical necessity for 67901 is established when ptosis significantly impacts the patient's vision.This should be documented through pre- and post-operative visual field tests demonstrating improvement in vision following the surgical repair.Insurance carriers typically require a specific percentage of improvement (varying by payer) to justify medical necessity.
The ophthalmologist or oculoplastic surgeon is responsible for performing the blepharoptosis repair.This includes patient assessment, surgical planning, performing the procedure, and providing postoperative care.
In simple words: The doctor fixes a drooping eyelid by attaching it to the forehead muscle with stitches or special tissue. This improves the eyelid's appearance and/or vision.
This CPT code, 67901, describes the surgical repair of blepharoptosis (drooping eyelid) using a frontalis muscle technique.The procedure involves attaching the drooping eyelid to the frontalis muscle in the forehead using sutures or donor tissue (such as banked fascia). This technique aims to improve the cosmetic appearance of the eyelid and/or alleviate any visual obstruction caused by the ptosis. The procedure includes prepping and anesthetizing the patient, placing sutures to hold the eyelid in place, making incisions in the eyelid and brow, creating a sling using suture material or donor fascia to attach the eyelid to the frontalis muscle, securing the material to achieve optimal eyelid height and contour, and closing the incisions in layers with sutures.
Example 1: A 65-year-old patient presents with significant ptosis in the right upper eyelid, impairing their peripheral vision.A visual field test demonstrates a 20% improvement with the eyelid taped up, indicating medical necessity.The surgeon performs a 67901 procedure using a suture sling., A 70-year-old patient with bilateral ptosis undergoes a bilateral 67901 procedure, with modifier 50 added.Banked fascia is used for the repair, and both eyes show improved visual fields postoperatively. Documentation includes pre- and post-operative photos and visual field testing., A 45-year-old patient experiences significant left-sided ptosis impacting vision due to neurologic injury.A 67901 procedure is performed with the addition of modifier E1, to indicate the left upper eyelid. The documentation includes imaging and a detailed description of surgical technique, including the material used (banked fascia).
* Detailed history and physical examination focusing on the visual impairment caused by the ptosis.* Preoperative visual field testing demonstrating a significant visual field deficit.* Intraoperative notes detailing surgical technique, materials used, and any complications.* Postoperative visual field testing showing improvement.* Operative report with detailed description of the procedure, including the use of suture or donor tissue.* Photographs documenting the preoperative and postoperative appearance of the eyelids.
** Accurate documentation is crucial for proper reimbursement.Payers may require additional information beyond the standard documentation to approve payment for procedures primarily performed for cosmetic purposes.Understanding the specific requirements of the payer is essential.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Ophthalmology, Oculoplastic Surgery
- Place of Service:Office, Ambulatory Surgery Center, Hospital (Inpatient or Outpatient)