Summary & Overview
CPT 67800: Chalazion Excision of Eyelid
CPT code 67800 represents the surgical removal of a chalazion, an eyelid nodule caused by blockage and chronic inflammation of an oil gland. This minor ophthalmic procedure is frequently performed in outpatient clinics and ambulatory surgical settings and is a common reason for referral to ophthalmology. Nationally, the code matters for procedural billing, surgical access, and alignment of coverage policies for low-complexity eyelid surgeries.
Key payers included in this review are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and typical sites of service, benchmarking information on utilization and coding frequency where available, and a concise summary of payer coverage patterns and policy considerations that affect prior authorization and payment. The publication also highlights common procedural modifiers and coding practice considerations relevant to documentation and claims submission.
This summary provides clinicians, coders, and policy analysts with the operational context for CPT code 67800, including what it represents, where it is typically performed, and which major payers are relevant for national billing and coverage discussions. Data not available in the input will be noted in detail sections.
Billing Code Overview
CPT code 67800 describes the excision of a chalazion, a small nodule that results from blockage of an eyelid oil gland and persistent inflammation. The procedure involves removal of the lesion, typically by an ophthalmologist or oculoplastic surgeon.
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Service type: Minor surgical procedure on the eyelid (chalazion removal)
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Typical site of service: Outpatient office or ambulatory surgical setting (ophthalmology clinic or minor procedure room)
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient presents to an ophthalmology clinic with a persistent, painful lump on the upper eyelid that has failed conservative treatment (warm compresses and topical antibiotic/steroid ointment) over several weeks. Examination reveals a localized, fluctuant nodule consistent with a chalazion. The provider reviews history and obtains informed consent, then schedules in-office eyelid procedure. The procedure is performed in an ambulatory clinic procedure room or outpatient ophthalmology office under local anesthesia. The workflow includes topical and/or injectable local anesthetic, eyelid eversion, incisional drainage or excision of the chalazion through an external or internal approach, hemostasis, and placement of any necessary ointment or pressure dressing. Post-procedure instructions include wound care, activity restrictions, and follow-up for suture removal or reassessment. Documentation includes indication, size and location of the lesion, anesthesia type and amount, technique (incision and curettage or excision), estimated blood loss (usually minimal), complications (if any), and patient tolerance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Data not available in the input. |
26 |