2025 CPT code 67903
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Repair of blepharoptosis; (tarso)levator resection or advancement, internal approach.
E1-E4 modifiers (upper left, lower left, upper right, lower right) can be used to specify the affected eyelid(s).Other modifiers may be applicable depending on the circumstances of the procedure; refer to CPT guidelines for complete information.
Medical necessity is often established through thorough documentation demonstrating functional impairment due to ptosis.This could involve documenting visual field deficits, improved vision post-op, or other impacts on quality of life.Payer requirements vary, so confirming specific guidelines with the relevant insurance provider is crucial.
The ophthalmologist or oculoplastic surgeon is responsible for performing the pre-operative evaluation, surgical procedure, and post-operative care of the patient undergoing this procedure. This includes assessing the patient's medical history, determining the best surgical technique, performing the surgery, and monitoring the patient's recovery.
In simple words: The doctor fixes a droopy eyelid by tightening the muscle that lifts it. This is done from the inside of the eyelid, making a small incision and repositioning the muscle to improve appearance or vision.
This CPT code encompasses the surgical repair of blepharoptosis (drooping eyelid) using an internal approach.The procedure involves accessing the levator muscle from inside the eyelid, resecting and shortening the tendon to correct the ptosis, and advancing the levator aponeurosis to the tarsus to restore the eyelid's proper position. The incision is then closed in layers with sutures.
Example 1: A 60-year-old patient presents with progressive drooping of the right upper eyelid, impacting their peripheral vision.The patient undergoes a 67903 procedure to correct the ptosis and improve visual field., A 45-year-old patient with congenital blepharoptosis affecting both upper eyelids undergoes bilateral 67903 procedures.The surgeon utilizes E1 and E3 modifiers to indicate the specific eyelids treated., A 72-year-old patient experiences eyelid drooping secondary to neurological issues. The surgeon performs a 67903 procedure, meticulously documenting the pre-operative assessment to demonstrate medical necessity for insurance purposes.
* Detailed history and physical examination, including visual acuity measurements before and after the procedure.* Pre-operative photographs documenting the degree of ptosis.* Intraoperative findings, including levator muscle function assessment.* Post-operative photographs demonstrating correction of ptosis.* Documentation of any complications encountered during or after the procedure.* Medical necessity documentation supporting the need for the surgery, including visual field testing if necessary.
** Always verify payer-specific guidelines, as coverage for this procedure may depend on the demonstration of medical necessity. Visual field testing may be required to establish medical necessity.The use of E-modifiers is for informational purposes only and does not impact reimbursement.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: This information requires access to a specific payer's fee schedule and may vary by location and other factors.RVUs are not directly provided within the CPT code itself.
- Global Days: The global period is not specified for this procedure and would need to be determined based on payer-specific guidelines.
- Payment Status: Active
- Modifier TC rule: TC modifier (Technical Component) is not applicable to this code as it represents the entire procedure.
- Fee Schedule: Fee schedule information is payer-specific and changes frequently. Consult current payer-specific fee schedules for the most accurate information.
- Specialties:Ophthalmology, Oculoplastic Surgery
- Place of Service:Ambulatory Surgical Center, Office, Hospital (Inpatient or Outpatient)