CPT 67911 Eyelid Retraction — Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 67911: Surgical Correction of Eyelid Retraction

CPT code 67911 designates surgical correction of eyelid retraction, a procedure that repositions an eyelid moving away from the ocular surface to restore protection and function. Nationally, this code is relevant to ophthalmology and oculoplastic practices and affects billing for outpatient surgical care in ambulatory surgical centers and hospital outpatient departments.

Key payers in coverage and reimbursement considerations include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context on the purpose and typical settings for the procedure, an overview of common modifiers, and what is and is not available in the provided input. The publication outlines benchmarks and policy-relevant items where available and highlights gaps in input data when details are not provided.

This report helps clinicians, practice managers, and billing staff understand the core clinical intent of CPT code 67911, typical service locations, and which major payers are relevant to national billing discussions. Data not available in the input is noted for transparency so readers can identify areas requiring supplemental payer- or institution-specific information.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare67911CPTeyelid-retractionoculoplastic-surgeryambulatory-surgeryophthalmologysurgical-repairoutpatient-procedure

Billing Code Overview

CPT code 67911 describes a surgical procedure to correct eyelid retraction, a condition in which the eyelid moves away from the surface of the eye. The procedure restores proper eyelid position and contact with the ocular surface to protect the eye and improve function.

Service type: Surgical repair of eyelid retraction
Typical site of service: Ambulatory surgical center or hospital outpatient department

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult experiencing lower eyelid retraction after prior eyelid surgery, facial trauma, or thyroid eye disease, presenting with ocular surface irritation, exposure keratopathy, tearing, or cosmetic concern. The ophthalmic plastic surgeon evaluates eyelid position, eyelid margin-to-cornea distance, ocular surface staining, lash position, and eyelid laxity. Conservative measures (lubrication, taping, and eyelid massage) may be tried first for mild cases. When surgical correction is indicated, the procedure 67911 (correction of eyelid retraction) is scheduled in an ambulatory surgery center or hospital outpatient department under local anesthesia with sedation or general anesthesia depending on complexity and patient factors. Intraoperative steps commonly include canthal and eyelid tissue release, spacer graft placement or repositioning of retractors, and adjustment of eyelid height. Postoperative workflow includes short-term observation in PACU, topical antibiotics and lubricants, follow-up visits for suture removal and monitoring of eyelid position, and documentation of pre- and post-operative measurements and informed consent.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting only the surgeon's professional service separate from technical facility charges.

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

CPT-67922-ENTROPION-REPAIR-THERMOCAUTERIZATION-LOWER-EYELID

CPT 67922: Thermocauterization Repair of Lower Eyelid Entropion

CPT-67900-BROW-REPAIR-FOR-PTOSIS

CPT 67900: Repair of Drooping Eyebrow (Brow Ptosis)

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

CPT 67909: Revision of Ptosis Repair, Levator Tension Reduction

CPT-67917-ECTROPION-REPAIR-EXTENSIVE-LOWER-EYELID

CPT 67917: Extensive Repair of Lower Eyelid Ectropion

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

CPT 67914: Repair of Lower Eyelid Ectropion with Sutures

CPT-67915-THERMOCAUTERIZATION-LOWER-EYELID-ECTROPION-REPAIR

CPT 67915: Thermocauterization Repair of Lower Eyelid Ectropion

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

CPT 67902: Frontalis Sling Repair of Eyelid Ptosis with Graft

CPT-67924-EXTENSIVE-REPAIR-ENTROPION-LOWER-EYELID

CPT 67924: Extensive Repair of Lower Eyelid Entropion

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

CPT 67912: Upper Eyelid Lid Load for Lagophthalmos Correction

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Taxonomy Code	Specialty	Notes
207P00000X	Ophthalmology	Ophthalmic plastic and reconstructive surgeons performing eyelid surgery.
207K00000X	Otolaryngology	Facial plastic surgeons who may perform periocular reconstructive procedures.
2080P0207X	Plastic Surgery	Plastic surgeons with oculoplastic expertise performing eyelid reconstruction.
363L00000X	Optometry	Co-management or pre-/post-operative evaluation in some systems (limited surgical role).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H02.122`	Ectropion, left lower eyelid	Lower eyelid malposition with outward turning commonly associated with eyelid retraction and may be corrected with `67911`.
`H02.121`	Ectropion, right lower eyelid	Right-sided equivalent; surgical correction indicated for exposure symptoms or corneal compromise.
`H02.141`	Entropion, right lower eyelid	Inward turning can coexist with retraction-related malposition; may alter surgical approach.
`H02.142`	Entropion, left lower eyelid	Left-sided entropion affecting surgical planning for eyelid repositioning.
`H05.22`	Thyroid orbitopathy, bilateral	Thyroid eye disease commonly causes eyelid retraction requiring surgical correction once disease is inactive.
`H16.233`	Exposure keratoconjunctivitis, bilateral	Corneal exposure changes from eyelid retraction that indicate need for corrective surgery to protect the ocular surface.
`T81.89XA`	Other complications of procedures, initial encounter	Used if postoperative complication from prior eyelid surgery contributes to retraction and further correction is required.
`S01.12XA`	Laceration of right eyelid and periocular area, initial encounter	Traumatic eyelid injuries can heal with scarring and retraction requiring corrective procedure.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67901`	Repair of entropion; with complex repair	Performed for inward-turning eyelid; may be done instead of or in conjunction with correction for retraction when eyelid malposition includes entropion features.
`67917`	Excision of lesion of eyelid, complicated	May be performed for concurrent eyelid lesions that require removal during corrective eyelid surgery.
`67912`	Repair of ptosis; revision	May be performed in the same operative setting when eyelid retraction correction requires levator advancement or adjustment for eyelid height.
`65778`	Implantation of eyelid spacer graft (e.g., hard palate, cartilage)	Commonly used adjunct to restore posterior lamellar support when correcting lower eyelid retraction.
`67411`	Repair of blepharoptosis; frontalis sling operation	May be part of combined procedures when eyelid malposition involves levator dysfunction and retraction correction alone is insufficient.

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