CPT 67921 Entropion Repair Reimbursement | OpenPayer

Summary & Overview

CPT 67921: Repair of Lower Eyelid Entropion with Sutures

CPT code 67921 denotes a suture repair of lower eyelid entropion, a common oculoplastic procedure that repositions the eyelid margin to prevent lashes from abrading the ocular surface. Nationally, this code is used by ophthalmic surgeons and oculoplastic specialists in outpatient surgical settings to treat symptomatic entropion that causes tearing, irritation, or corneal risk. The code matters because timely repair reduces complications, prevents vision-threatening sequelae, and generates discrete surgical billing for specialty providers.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks and coverage considerations for payers, a summary of typical sites of service and clinical context, and guidance on how 67921 is categorized within surgical service lines. The publication summarizes common billing modifiers and payer lists (data not available for some fields) and outlines how the procedure fits into ambulatory ophthalmic surgical workflows. This review is intended for coding professionals, revenue cycle staff, and clinical leaders seeking a national-level reference on procedural classification and practice context for CPT code 67921.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare67921CPTentropion repairoculoplasticseyelid surgeryambulatory surgeryophthalmologysurgical-procedurereconstructive-surgery

Billing Code Overview

CPT code 67921 describes a surgical repair of entropion of the lower eyelid using sutures to evert and stabilize the eyelid margin. This procedure addresses inward turning of the lower eyelid and eyelashes that can cause tearing, irritation, corneal abrasion, or chronic ocular surface symptoms.

Service type: Oculoplastic surgical procedure
Typical site of service: Ambulatory surgical center or hospital outpatient department; may be performed in an ophthalmology office with appropriate surgical facilities

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient presents to an ophthalmology clinic with progressive inward turning of the lower eyelid and lashes causing corneal irritation, foreign body sensation, and reflex tearing. On examination the lower eyelid margin is rotated inward with lashes contacting the cornea and conjunctival injection. Conservative measures (lubrication, eyelid taping) provided temporary relief but symptoms persisted and there is early corneal epithelial breakdown. The ophthalmologist discusses and schedules a surgical repair using everting sutures to correct the involutional entropion of the lower lid.

The clinical workflow includes preoperative evaluation (history, ocular surface assessment, topical anesthesia or sedation decision), informed consent, marking of suture placement, intraoperative placement of full-thickness everting sutures to rotate the eyelid margin outward, hemostasis, postoperative topical antibiotic and anti-inflammatory medications, and brief recovery with discharge instructions. Follow-up visits occur at 1 week to assess suture position and wound healing and at 4–6 weeks for definitive outcome assessment.

Coding Specifications

Modifier	Description	When to Use
`25`	Data not available in the input.	Data not available in the input.

CPT 67923: Tarsal Wedge Excision for Lower Eyelid Entropion

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

CPT 67922: Thermocauterization Repair of Lower Eyelid Entropion

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

CPT 67917: Extensive Repair of Lower Eyelid Ectropion

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

CPT 67906: Ptosis Repair with Superior Rectus Suspension and Graft

CPT-67911-EYELID-RETRACTION-CORRECTION

CPT 67911: Surgical Correction of Eyelid Retraction

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

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

CPT-67900-BROW-REPAIR-FOR-PTOSIS

CPT 67900: Repair of Drooping Eyebrow (Brow Ptosis)

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

CPT 67902: Frontalis Sling Repair of Eyelid Ptosis with Graft

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

CPT 67912: Upper Eyelid Lid Load for Lagophthalmos Correction

CPT-67904-LEVATOR-REPAIR-PTOSIS-OUTER-APPROACH

CPT 67904: Levator Muscle Repair for Ptosis, Outer Approach

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Taxonomy Code	Specialty	Notes
`207K00000X`	Ophthalmology	Primary specialty performing lower eyelid entropion repair.
`207KA0003X`	Oculoplastic Surgery	Subspecialty focusing on eyelid reconstructive procedures; commonly performs `67921`.
`261QM0800X`	General Surgery	May perform eyelid procedures in settings without ophthalmic subspecialists (less common).
`363L00000X`	Family Medicine	May perform minor eyelid procedures in some outpatient settings (rare).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H02.821`	Entropion of right lower eyelid	Direct indication for lower eyelid entropion repair on the right side.
`H02.822`	Entropion of left lower eyelid	Direct indication for lower eyelid entropion repair on the left side.
`H02.823`	Entropion of bilateral lower eyelids	Indicates bilateral disease; may justify bilateral procedure or modifier use.
`H02.89`	Other disorders of eyelid	Relevant when entropion occurs with other eyelid disorders affecting surgical planning.
`H16.233`	Punctate keratitis, bilateral	Represents corneal epithelial compromise from lash-corneal contact; supports medical necessity for repair.
`H10.451`	Chronic conjunctivitis of right eye	Chronic conjunctival irritation secondary to entropion; supports symptomatology for surgery.
`S01.11XA`	Laceration without foreign body of right eyelid and periocular area, initial encounter	May be present if traumatic component contributes to eyelid malposition requiring repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67820`	Repair of entropion; lower eyelid, simple	Alternative or adjunct simple entropion repair technique; may be used for less complex cases.
`67900`	Repair of blepharoptosis; external approach	Performed when ptosis correction is required concurrently or in staged fashion; addresses eyelid position different from entropion repair.
`67904`	Repair of blepharoptosis; internal approach	Alternative approach to ptosis repair that may be performed in the same patient when eyelid margin position needs addressing.
`12001`	Simple repair of superficial wounds; 2.5 cm or less	Used for incidental small laceration repairs of the eyelid skin during the same encounter if applicable.
`99024`	Postoperative follow-up visit, global period	Reporting follow-up care related to the surgical procedure when payer requires separate reporting for postoperative visits.
`20550`	Injection(s); single tendon sheath, ligament, or ganglion cyst	Example of an unrelated procedure not usually combined; Data not available in the input.

`11`	Normal, uncomplicated procedural service	When the procedure is performed normally without unusual circumstances and is the provider's usual service level.
`22`	Increased procedural service	When the repair required substantially greater effort, time, or complexity than usual (document reason and duration).
`23`	Unusual anesthesia	When general anesthesia or MAC was required for reasons outside typical local anesthetic use for this procedure.
`26`	Professional component	When only the professional component of a bundled service is billed separately (rare for this CPT).
`50`	Bilateral procedure	When `67921` is performed on both lower eyelids and payer allows bilateral modifier reporting.
`51`	Multiple procedures	When `67921` is billed with other distinct procedures performed the same session (follow payer rules).
`52`	Reduced services	When the procedure is partially reduced or not completed as planned but still performed.
`53`	Discontinued procedure	When the procedure was started but terminated due to unforeseen circumstances.
`62`	Two surgeons	When two surgeons with distinct specialties work together performing distinct parts of the procedure.
`63`	Procedure performed on infants less than 4 kg	When applicable for neonatal cases meeting weight criteria.
`78`	Return to OR for related procedure during global period	For unplanned return to the operating room related to the original procedure during the postoperative global period.
`79`	Data not available in the input.	Data not available in the input.

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