Summary & Overview
CPT 67901: Frontalis Suspension for Ptosis Repair
CPT code 67901 denotes a frontalis suspension procedure to correct ptosis by attaching the upper eyelid to the frontalis muscle with suture or donor tissue. This reconstructive eyelid surgery addresses both functional visual obstruction and cosmetic deformity, and is commonly performed in ambulatory surgery centers or hospital operating rooms. Nationally, the code is relevant to ophthalmic and oculoplastic surgical practice patterns, coverage determinations for reconstructive versus cosmetic intent, and appropriate site-of-service billing.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and service settings for the procedure, typical payer considerations, and commonly tracked benchmarks and policy topics related to surgical eyelid reconstruction. The publication outlines how the procedure is described for billing, what clinical context typically supports medical necessity, and which elements of the surgical setting and documentation influence reimbursement pathways.
The report is intended to inform billing and coding professionals, clinical leaders in ophthalmology and plastic surgery, and payer policy teams about the clinical definition, billing context, and high-level payer landscape for CPT code 67901. Data not available in the input will be noted where applicable in subsequent sections.
Billing Code Overview
CPT code 67901 describes a surgical procedure to correct a drooping eyelid (ptosis) by attaching the eyelid to the frontalis muscle in the forehead using a suture or donor tissue. The procedure is performed to improve cosmetic appearance or to remove obstruction of a patient’s vision.
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Service type: Eyelid ptosis repair via frontalis suspension
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Typical site of service: Ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient presents to an oculoplastic surgeon with progressive unilateral ptosis causing visual field obstruction and difficulty with reading and driving. Conservative measures, including eyelid strengthening exercises and temporary ptosis crutches, have failed to restore adequate eyelid elevation. Examination documents severe levator dysfunction with good frontalis muscle function, significant superior visual field deficit on formal visual field testing, and cosmetic concern. The decision is made to perform a frontalis suspension procedure to elevate the upper eyelid by attaching the tarsal plate or eyelid margin to the frontalis muscle using autogenous fascia lata or a synthetic sling, consistent with CPT 67901.
Typical clinical workflow:
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Preoperative evaluation in an outpatient oculoplastics clinic with documented visual obstruction and measurement of margin-reflex distance and levator function.
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Preoperative counseling, medical clearance, and informed consent obtained by the operating surgeon.
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Procedure performed in an ambulatory surgery center or hospital outpatient surgical suite under monitored anesthesia care or general anesthesia. Local anesthesia with sedation is also commonly used for select patients.
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Intraoperative steps include exposure of the superior tarsus, creation of a frontalis sling using autogenous fascia lata or alloplastic material, fixation to the tarsus and frontalis muscle, and intraoperative adjustment for symmetry and eyelid height.
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Postoperative recovery in the PACU with instructions for wound care, activity restrictions, and follow-up within 1 week for wound check and suture removal as indicated. Visual field or photographic documentation may be performed pre- and postoperatively to support functional improvement.