Summary & Overview
CPT 67805: Removal of Multiple Chalazia from Eyelids
CPT code 67805 covers the surgical removal of multiple chalazia from different eyelids. This minor ophthalmic procedure is commonly performed by ophthalmologists and oculoplastic surgeons to treat persistent or symptomatic eyelid lesions that do not respond to conservative therapy. Nationally, the code matters because it standardizes reporting for a frequent, low-complexity surgical service that impacts outpatient ophthalmic surgical volumes, resource planning, and payment policy for eyelid procedures.
Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise clinical context for when the procedure is used, typical sites of service, and the common operational considerations tied to billing this code. The publication also summarizes benchmark elements such as utilization patterns, payer coverage nuances, and potential policy or coding guidance relevant to ambulatory ophthalmic procedures. Where specific data points are not provided, the text notes that those data are not available in the input.
This overview is intended for clinicians, practice managers, and policy analysts who need a clear, national-level summary of the code’s clinical purpose, billing context, and where to focus further review for payer-specific coverage and reimbursement details.
Billing Code Overview
CPT code 67805 describes a surgical procedure to remove multiple chalazia, which are small, localized masses or cysts in the eyelid. The procedure involves excision of numerous chalazia from different eyelids during the same operative session.
Service Type: Minor ophthalmic surgical procedure for eyelid lesions
Typical Site of Service: Ophthalmology clinic procedure room or ambulatory surgery center, depending on clinical complexity and patient factors.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric individual presenting to an ophthalmology clinic or ambulatory surgical center with multiple symptomatic chalazia affecting one or both eyelids. The patient reports focal eyelid swelling, tenderness, and localized eyelid nodules that have persisted despite conservative therapy (warm compresses, lid hygiene, topical antibiotics or steroid ointments). Examination confirms multiple discrete meibomian gland chalazia on the upper and/or lower eyelids. The clinician discusses options and schedules an in-office minor procedure under local anesthesia (or monitored anesthesia care in select cases). During the visit, informed consent is obtained, topical and/or infiltrative local anesthesia is administered, and the provider performs incision and drainage or curettage of multiple chalazia through the conjunctival or external approach as clinically indicated. Hemostasis is achieved, topical antibiotic/steroid ointment is applied, and post-procedure instructions are reviewed. Typical documentation includes number and location of chalazia treated, approach (internal vs external), anesthesia used, complications (if any), and follow-up plan. Common sites of service are outpatient ophthalmology clinic or ambulatory surgical center depending on anesthesia and patient complexity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician’s professional portion separate from technical services (rare for this in-office procedure). |