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CPT 67904: Levator Muscle Repair for Ptosis, Outer Approach

CPT code 67904 denotes levator muscle repair for ptosis using a lateral (outer eyelid) approach to tighten the muscle and elevate a drooping eyelid for cosmetic or functional reasons. This procedure is relevant nationally as a commonly performed oculoplastic operation that affects visual function and facial appearance, with implications for clinical coding, utilization, and coverage determinations.

Key payers examined in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical indication and procedure, typical sites of service, and the payer landscape. The report summarizes coding benchmarks, common modifier usage where applicable, and typical billing considerations tied to this ophthalmic surgical service. It also situates the code within clinical practice by outlining when levator tightening via an outer approach is used to correct ptosis and the expected service setting.

This summary is intended for national audiences seeking a clear, practical reference to the clinical meaning, billing context, and payer coverage environment for CPT code 67904.

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Billing Code Overview

CPT code 67904 describes a surgical procedure to repair a drooping eyelid (ptosis) by tightening the levator muscle that controls eyelid elevation. The surgeon accesses the levator muscle from the outer side of the eyelid to improve the eyelid's cosmetic appearance or to remove obstruction to vision.

Service type: Ophthalmic eyelid surgery / levator muscle repair

Typical site of service: Outpatient ambulatory surgery center or hospital outpatient department; may also be performed in an office surgical suite when appropriate

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Find policies, billing codes, payers, states, and providers

CPT 67904: Levator Muscle Repair for Ptosis, Outer Approach

This summary is intended for national audiences seeking a clear, practical reference to the clinical meaning, billing context, and payer coverage environment for CPT code 67904.

Customize your policy alerts

Sign up for cpt 67904 policy alerts

Get alerted when payer policies referencing 67904 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Ophthalmic eyelid surgery / levator muscle repair

Typical site of service: Outpatient ambulatory surgery center or hospital outpatient department; may also be performed in an office surgical suite when appropriate

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient presents to an ophthalmology clinic with progressive unilateral drooping of the right upper eyelid (ptosis) that interferes with the superior visual field and daily activities. The ophthalmologist documents decreased eyelid elevation and diminished levator function on exam, correlating with patient-reported functional impairment and cosmetic concern. After discussing risks, benefits, and alternatives, the provider schedules an anterior approach levator advancement/shortening procedure to tighten the levator palpebrae superioris tendon from the outer (anterior) surface of the eyelid to elevate the lid and restore eyelid contour.

The clinical workflow includes preoperative evaluation (history, ocular surface assessment, levator function measurement, photography), informed consent, operative repair under local or monitored anesthesia care in an ambulatory surgical center or hospital outpatient department, intraoperative adjustment of eyelid height and contour, and routine postoperative visits for suture removal and wound check. Typical documentation includes indication (functional ptosis or cosmetic ptosis), levator function grade, laterality, anesthesia type, operative technique noting access from the anterior eyelid, estimated blood loss, and postoperative instructions.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon’s professional component separate from facility technical component.
`50`	Bilateral procedure	Use when identical procedure is performed on both upper eyelids during the same operative session.
`51`	Multiple procedures	Use when additional distinct procedures are performed during the same operative session (e.g., blepharoplasty).
`52`	Reduced services	Use when the procedure is intentionally partially reduced or not completed as described.
`53`	Discontinued procedure	Use when procedure is started but terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct parts of the surgery.
`66`	Surgical team (multiple specialists)	Use when a surgical team approach is documented.
`76`	Repeat procedure by same physician	Use for an unplanned repeat of the procedure by the same physician during the postoperative global period.
`77`	Repeat procedure by another physician	Use for an unplanned repeat by a different physician during the global period.
`78`	Unplanned return to OR for related procedure during the global period	Use when patient returns to the operating room for a related complication requiring revision.
`79`	Unrelated procedure or service by the same physician during global period	Use when an unrelated procedure is performed during the global period.
`RT`	Right side	Use to designate the right eyelid when laterality modifiers are required.
`LT`	Left side	Use to designate the left eyelid when laterality modifiers are required.
`GA`	Waiver of liability statement on file	Use when a signed Advance Beneficiary Notice (ABN) or payer waiver is on file for an expected noncovered service.

Taxonomy Code	Specialty	Notes
207K00000X	Ophthalmology	Most common specialty performing levator advancement/ptosis repair.
2084P0800X	Oculoplastic Surgery	Subspecialists focused on eyelid and periocular surgery.
207R00000X	Plastic Surgery	Plastic surgeons experienced in eyelid reconstruction and aesthetic eyelid procedures.
208600000X	Otolaryngology	Some head & neck surgeons with oculofacial training perform eyelid procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G52.0`	Disorders of cranial nerve III	Ptosis due to oculomotor nerve palsy affecting levator function; may prompt levator repair if chronic and stable or for cosmetic reasons.
`H02.401`	Unspecified ptosis of right eyelid	Directly indicates ptosis affecting the right upper eyelid; common primary diagnosis for levator tightening.
`H02.402`	Unspecified ptosis of left eyelid	Directly indicates ptosis affecting the left upper eyelid.
`H02.403`	Unspecified ptosis of bilateral eyelids	Indicates bilateral ptosis when both upper lids are affected; may justify bilateral `67904` or bilateral procedure coding considerations.
`H02.09`	Ptosis of eyelid, unspecified	General ptosis diagnosis when laterality or specific type not otherwise classified; used in initial documentation pending laterality specification.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67311`	Repair of congenital ptosis; frontalis suspension (e.g., fascial sling)	Alternative surgical technique for severe levator dysfunction when levator tightening is insufficient.
`15822`	Upper eyelid blepharoplasty	Commonly performed concurrently to remove redundant eyelid skin and improve contour.
`66984`	Extracapsular cataract removal with intraocular lens implant	Frequently part of comprehensive ophthalmic surgical care but distinct from eyelid surgery; may occur in separate sessions.
`99024`	Postoperative follow-up visit, global period, following surgery	Used for routine postoperative visits related to the procedure within the global period.
`99070`	Supplies and materials (e.g., wound care supplies)	Billed when additional nonroutine surgical supplies are provided and separately payable.

Related Codes

CPT-67900-BROW-REPAIR-FOR-PTOSIS

CPT 67900: Repair of Drooping Eyebrow (Brow Ptosis)

CPT-67901-FRONTALIS-SUSPENSION-PTOSIS-REPAIR

CPT 67901: Frontalis Suspension for Ptosis Repair

CPT-67902-FRONTALIS-SLING-EYELID-PTOSIS-REPAIR-WITH-GRAFT

CPT 67902: Frontalis Sling Repair of Eyelid Ptosis with Graft

CPT-67903-LEVATOR-RESECTION-INTERNAL-APPROACH-PTOSIS-REPAIR

CPT 67903: Levator Muscle Repair for Ptosis (Internal Approach)

CPT-67906-PTOSIS-REPAIR-SUPERIOR-RECTUS-SUSPENSION-WITH-GRAFT

CPT 67906: Ptosis Repair with Superior Rectus Suspension and Graft

CPT-67908-FASANELLA-SERVAT-PTOSIS-REPAIR-OCULOPLASTIC-SURGERY

CPT 67908: Eyelid Ptosis Repair (Fasanella–Servat Procedure)

CPT-67909-PTOSIS-REVISION-REPAIR-LEVATOR-TENSION-REDUCTION

CPT 67909: Revision of Ptosis Repair, Levator Tension Reduction

CPT-67911-EYELID-RETRACTION-CORRECTION

CPT 67911: Surgical Correction of Eyelid Retraction

CPT-67912-LID-LOAD-FOR-LAGOPHTHALMOS-UPPER-EYELID

CPT 67912: Upper Eyelid Lid Load for Lagophthalmos Correction

CPT-67914-ECTROPION-REPAIR-LOWER-EYELID-SUTURE-REPAIR

CPT 67914: Repair of Lower Eyelid Ectropion with Sutures

Showing 1–10 of 17

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon’s professional component separate from facility technical component.
`50`	Bilateral procedure	Use when identical procedure is performed on both upper eyelids during the same operative session.
`51`	Multiple procedures	Use when additional distinct procedures are performed during the same operative session (e.g., blepharoplasty).
`52`	Reduced services	Use when the procedure is intentionally partially reduced or not completed as described.
`53`	Discontinued procedure	Use when procedure is started but terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct parts of the surgery.
`66`	Surgical team (multiple specialists)	Use when a surgical team approach is documented.
`76`	Repeat procedure by same physician	Use for an unplanned repeat of the procedure by the same physician during the postoperative global period.
`77`	Repeat procedure by another physician	Use for an unplanned repeat by a different physician during the global period.
`78`	Unplanned return to OR for related procedure during the global period	Use when patient returns to the operating room for a related complication requiring revision.
`79`	Unrelated procedure or service by the same physician during global period	Use when an unrelated procedure is performed during the global period.
`RT`	Right side	Use to designate the right eyelid when laterality modifiers are required.
`LT`	Left side	Use to designate the left eyelid when laterality modifiers are required.
`GA`	Waiver of liability statement on file	Use when a signed Advance Beneficiary Notice (ABN) or payer waiver is on file for an expected noncovered service.

Taxonomy Code	Specialty	Notes
207K00000X	Ophthalmology	Most common specialty performing levator advancement/ptosis repair.
2084P0800X	Oculoplastic Surgery	Subspecialists focused on eyelid and periocular surgery.
207R00000X	Plastic Surgery	Plastic surgeons experienced in eyelid reconstruction and aesthetic eyelid procedures.
208600000X	Otolaryngology	Some head & neck surgeons with oculofacial training perform eyelid procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G52.0`	Disorders of cranial nerve III	Ptosis due to oculomotor nerve palsy affecting levator function; may prompt levator repair if chronic and stable or for cosmetic reasons.
`H02.401`	Unspecified ptosis of right eyelid	Directly indicates ptosis affecting the right upper eyelid; common primary diagnosis for levator tightening.
`H02.402`	Unspecified ptosis of left eyelid	Directly indicates ptosis affecting the left upper eyelid.
`H02.403`	Unspecified ptosis of bilateral eyelids	Indicates bilateral ptosis when both upper lids are affected; may justify bilateral `67904` or bilateral procedure coding considerations.
`H02.09`	Ptosis of eyelid, unspecified	General ptosis diagnosis when laterality or specific type not otherwise classified; used in initial documentation pending laterality specification.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67311`	Repair of congenital ptosis; frontalis suspension (e.g., fascial sling)	Alternative surgical technique for severe levator dysfunction when levator tightening is insufficient.
`15822`	Upper eyelid blepharoplasty	Commonly performed concurrently to remove redundant eyelid skin and improve contour.
`66984`	Extracapsular cataract removal with intraocular lens implant	Frequently part of comprehensive ophthalmic surgical care but distinct from eyelid surgery; may occur in separate sessions.
`99024`	Postoperative follow-up visit, global period, following surgery	Used for routine postoperative visits related to the procedure within the global period.
`99070`	Supplies and materials (e.g., wound care supplies)	Billed when additional nonroutine surgical supplies are provided and separately payable.

Related Codes

CPT-67900-BROW-REPAIR-FOR-PTOSIS

CPT 67900: Repair of Drooping Eyebrow (Brow Ptosis)

CPT-67901-FRONTALIS-SUSPENSION-PTOSIS-REPAIR

CPT 67901: Frontalis Suspension for Ptosis Repair

CPT-67902-FRONTALIS-SLING-EYELID-PTOSIS-REPAIR-WITH-GRAFT

CPT 67902: Frontalis Sling Repair of Eyelid Ptosis with Graft

CPT-67903-LEVATOR-RESECTION-INTERNAL-APPROACH-PTOSIS-REPAIR

CPT 67903: Levator Muscle Repair for Ptosis (Internal Approach)

CPT-67906-PTOSIS-REPAIR-SUPERIOR-RECTUS-SUSPENSION-WITH-GRAFT

CPT 67906: Ptosis Repair with Superior Rectus Suspension and Graft

CPT-67908-FASANELLA-SERVAT-PTOSIS-REPAIR-OCULOPLASTIC-SURGERY

CPT 67908: Eyelid Ptosis Repair (Fasanella–Servat Procedure)

CPT-67909-PTOSIS-REVISION-REPAIR-LEVATOR-TENSION-REDUCTION

CPT 67909: Revision of Ptosis Repair, Levator Tension Reduction

CPT-67911-EYELID-RETRACTION-CORRECTION

CPT 67911: Surgical Correction of Eyelid Retraction

CPT-67912-LID-LOAD-FOR-LAGOPHTHALMOS-UPPER-EYELID

CPT 67912: Upper Eyelid Lid Load for Lagophthalmos Correction

CPT-67914-ECTROPION-REPAIR-LOWER-EYELID-SUTURE-REPAIR

CPT 67914: Repair of Lower Eyelid Ectropion with Sutures

Showing 1–10 of 17

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.