2025 CPT code 67906
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Repair of blepharoptosis using a superior rectus muscle technique with a fascial sling (includes obtaining fascia).
Modifiers may apply depending on the circumstances of the procedure. Examples include modifiers 50 (bilateral procedure), 22 (increased procedural services), and E1-E4 (to identify the specific eyelid(s) affected).
Medical necessity for code 67906 is primarily established when ptosis causes clinically significant visual impairment. Documentation should clearly demonstrate a measurable improvement in visual fields after temporary elevation of the eyelid to justify the surgery's necessity.Cosmetic reasons alone are often insufficient for reimbursement.
The ophthalmologist or qualified surgeon performs the procedure. This includes pre-operative preparation, making incisions, transferring the eyelid's movement to the superior rectus muscle, creating and securing the fascial sling, and closing the incisions.
In simple words: The doctor fixes a droopy eyelid by attaching it to a muscle in the eye socket using a tissue graft from another part of the body. This improves the eyelid's appearance and may improve vision if the drooping eyelid is obstructing sight.It involves small incisions, and sutures are used to close them.
This procedure involves repairing a drooping eyelid (blepharoptosis) by attaching it to the superior rectus muscle of the orbit.A fascial sling is created using a tissue graft from another location on the patient's body (e.g., thigh) and is used to create a sling to the frontalis muscle.This sling is then secured to achieve optimal eyelid height and contour. The procedure is performed using a superior rectus muscle technique, with incisions made in the eyelid and brow. The movement of the upper eyelid is transferred to the superior rectus muscle above it. The incisions are then closed in layers with sutures.
Example 1: A 65-year-old patient presents with significant ptosis in the right upper eyelid, causing impaired vision. Visual field testing demonstrates a 20% improvement in visual field after taping the eyelid to simulate the surgical effect. The surgeon performs a superior rectus muscle technique with a fascial sling using autologous fascia from the thigh., A 72-year-old patient complains of cosmetic concerns related to significant ptosis of both upper eyelids.They do not report any visual impairment.After explaining the procedure and obtaining informed consent, the surgeon performs bilateral blepharoptosis repair (using code 67906 with modifier 50) as a cosmetic procedure., A 50-year-old patient experiences ptosis in the left upper eyelid that is causing significant visual obstruction. Following a thorough assessment and visual field testing showing a 15% improvement with eyelid elevation, the surgeon performs a superior rectus muscle technique with a fascial sling, utilizing allograft fascia due to the patient’s medical history precluding autograft harvesting.
* Detailed history and physical examination documenting the severity of ptosis and its impact on vision (if applicable).* Preoperative visual field testing to quantify the degree of visual impairment caused by ptosis (if applicable).* Intraoperative notes detailing the technique used (superior rectus muscle technique with fascial sling), the type and source of fascial graft, and the placement of the sling.* Postoperative visual field testing (if applicable).* Photographs showing the preoperative and postoperative appearance of the eyelids.
** Ensure thorough documentation of medical necessity, especially for cosmetic procedures.Payer policies vary regarding coverage for blepharoptosis repair when performed solely for cosmetic reasons.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: This information is not available in the provided text.Refer to current Medicare fee schedules and other payer-specific information for RVU data.
- Global Days: This information is not provided.The global period will depend on payer policies.
- Payment Status: Active
- Modifier TC rule: This information is not included in the provided source. Refer to current CPT guidelines and payer-specific rules.
- Fee Schedule: Fee schedule information varies by payer and year. Consult historical fee schedules or relevant payers for this data.
- Specialties:Ophthalmology, Plastic Surgery
- Place of Service:Office, Ambulatory Surgery Center, Hospital Outpatient