Summary & Overview
CPT 67906: Ptosis Repair with Superior Rectus Suspension and Graft
CPT code 67906 represents a specialized ophthalmic surgical procedure to correct ptosis by suspending the upper eyelid to the superior rectus muscle using a tissue graft. This operation is clinically indicated when levator function is insufficient and when correction is required for functional vision improvement or cosmetic reasons. Nationally, procedures coded with 67906 have significance for ophthalmology and oculoplastic service lines due to their surgical complexity, potential need for specialized operating environments, and implications for coverage policies.
Key payers in analyses of this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for 67906, the typical sites of service, and the common payer considerations that influence coverage and prior authorization practices. The publication outlines where benchmarks and policy updates commonly affect utilization and reimbursement for complex eyelid surgery, and highlights operational implications for surgical scheduling and facility selection. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 67906 describes a surgical procedure to correct a drooping upper eyelid (ptosis) by attaching the eyelid to the superior rectus muscle of the orbit. The repair is performed with the aid of a tissue graft taken from elsewhere on the patient’s body and may be undertaken to improve cosmetic appearance or to remove an obstruction to vision.
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Service type: Surgical eyelid repair using a superior rectus suspension with tissue graft (operative procedure)
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with significant unilateral or bilateral ptosis causing visual field obstruction or a notable cosmetic concern. The patient presents to an oculoplastic surgeon after evaluation in clinic, where visual acuity, margin-reflex distance (MRD1), levator function, and ocular motility are documented. Preoperative testing includes ophthalmic photography, possible visual field testing if vision obstruction is reported, and assessment for neuromuscular causes. The operative plan for 67906 (ptosis repair using a superior rectus suspension with autologous tissue graft) is selected when levator function is poor or when previous levator surgery has failed and a stronger suspension to the superior rectus is required.
The clinical workflow includes preoperative consent and marking, anesthesia (general or monitored anesthesia care), harvest of autologous tissue graft (commonly fascia lata), exposure of the superior rectus muscle and superior tarsal plate, fixation of the graft between the tarsus and the superior rectus to elevate the lid, intraoperative adjustment for symmetry, closure, and postoperative monitoring for eyelid height, lagophthalmos, and ocular surface exposure. Postoperative follow-up occurs within 1 week, then at 1 month and 3 months to assess functional and cosmetic outcomes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary Procedure |