Find policies, billing codes, payers, states, and providers
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.
Customize your policy alerts
Sign up for cpt 67906 policy alerts
Get alerted when payer policies referencing 67906 are released or updated.
Monitor payer policy activity
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.
-
Service type: Surgical eyelid repair using a superior rectus suspension with tissue graft (operative procedure)
-
Typical site of service: Hospital operating room or ambulatory surgery center