Summary & Overview
CPT 67850: Destruction of Eyelid Margin Lesion ≤1 cm
CPT code 67850 designates the destruction of a small eyelid margin lesion (≤1 cm) located between the anterior and posterior lid edges of any eyelid. This concise surgical code captures a common minor ophthalmic procedure used to remove benign or malignant lesions that involve the lid margin, with implications for vision, comfort, and eyelid function. Nationally, accurate coding of eyelid lesion destruction is important for clinical documentation, payer adjudication, and surveillance of ambulatory ophthalmic surgical volumes.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a focused review of the clinical context for 67850, typical sites of service, common payer coverage considerations, and benchmarking topics relevant to outpatient ophthalmic procedures. The publication outlines coding nuances, utilization benchmarks where available, and policy trends that affect payment and prior authorization practices for minor eyelid surgeries.
This report is intended for clinicians, billing professionals, and policy analysts seeking a clear summary of what CPT code 67850 represents, how it is used in practice, and which payers commonly cover these services. Data not available in the input has been noted where applicable.
Billing Code Overview
CPT code 67850 describes destruction of a small lesion of the eyelid margin no larger than 1 cm, performed on the tissue between the anterior and posterior lid edges of any of the four eyelids. This procedure is a minor ophthalmic surgical intervention focused on removal of localized eyelid lesions.
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Service type: Minor eyelid lesion destruction (outpatient ophthalmic procedure)
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Typical site of service: Ambulatory surgery center, hospital outpatient department, or office-based ophthalmology/oculoplastic clinic
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to an ophthalmology clinic with a 4 mm symptomatic lesion on the upper right eyelid margin causing irritation and occasional bleeding. The ophthalmologist performs a focused evaluation, documents lesion size and location along the anterior lid margin, obtains informed consent, prepares topical or local anesthesia, and destroys the lesion using cautery or cryotherapy in an outpatient procedure room. The procedure is brief, typically ambulatory, and performed by an ophthalmologist or oculoplastic surgeon. Post-procedure instructions and wound care are provided; if pathology is required, a separate biopsy or excision and pathology coding would apply. Typical site of service is an ophthalmology office or ambulatory surgical center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Physician or practitioner primary service | Use when the physician performs the primary service and documents typical effort for the visit with the procedure. |
22 | Increased procedural services | Use when documented work substantially exceeds usual service (rare for small lid lesion destruction). |