Summary & Overview
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.
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
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. |