Summary & Overview

CPT 67999: Unlisted Procedure on Eyelid

CPT code 67999 denotes an unlisted eyelid procedure and is used when a specific CPT code does not describe the surgical service performed on the eyelid. As an unlisted procedure code, 67999 is important for documenting and billing for uncommon or novel eyelid surgeries, ensuring those services are captured in claims and considered for payment nationally. Its use requires clear documentation to explain the nature and complexity of the procedure.

Key payers relevant to national practice patterns include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect an overview of how 67999 functions in billing workflows, what clinical situations typically prompt its use, and common administrative considerations when submitting claims. The analysis covers benchmark considerations for unlisted eyelid procedures, documentation expectations, and policy elements that affect adjudication across major payers. Data not available in the input for payer-specific coverage rules, associated taxonomies, and ICD-10 pairings is noted where relevant. This publication is intended to clarify the role of CPT code 67999 in clinical billing and to summarize the policy and documentation context readers should consider when encountering unlisted eyelid procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare67999CPTophthalmologyeyelid surgeryunlisted proceduresurgical billingambulatory surgeryoutpatient surgery

Billing Code Overview

CPT code 67999 is an unlisted procedure code used to report surgical or procedural services performed on the eyelids that are not described by a specific CPT code. It captures unique or uncommon eyelid procedures for which no precise code exists.

Service type: Ophthalmic/plastic surgical procedure on the eyelid
Typical site of service: Ambulatory surgical center or hospital outpatient facility

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient presents to an ophthalmic plastic surgery clinic with a complex eyelid lesion involving distortion of the eyelid margin and recurrent symptoms after prior standard procedures. Examination shows focal cicatricial entropion with trichiasis and scarred lid tissue that does not fit a specific existing CPT descriptor. The surgeon plans a customized reconstructive eyelid procedure under monitored anesthesia care in an ambulatory surgical center. The workflow includes preoperative evaluation by the ophthalmologist, informed consent describing an unlisted eyelid procedure, photography and measurements, procedural coding as an unlisted eyelid service using 67999, operative documentation detailing technique and time, intraoperative pathology or biopsy as indicated, and submission of the claim with an operative report and applicable modifiers and diagnosis codes to payors for clinical review. Postoperative follow-up appointments are scheduled for wound checks and suture removal.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for the unlisted eyelid procedure and supported by detailed documentation.

Taxonomy Code	Specialty	Notes
207N00000X	Ophthalmology	Oculoplastic surgeons and general ophthalmologists performing eyelid surgical procedures.
2084P0800X	Plastic Surgery	Plastic and reconstructive surgeons who perform complex eyelid and periocular reconstructions.
363A00000X	Anesthesiology	Anesthesiologists providing monitored anesthesia care or general anesthesia for eyelid surgeries.
208000000X	General Surgery	General surgeons with reconstructive experience in eyelid procedures (less common).

ICD-10 Code	Description	Clinical Relevance
`H02.12`	Cicatricial entropion of right lower eyelid	Cicatricial entropion may require reconstructive eyelid surgery not described by standard codes, leading to use of `67999`.
`H02.13`	Cicatricial entropion of left lower eyelid	As above for the left side; laterality affects coding and modifier use.
`H02.221`	Entropion of right upper eyelid	Entropion repair techniques vary; atypical or combined procedures may be reported with `67999`.
`H02.222`	Entropion of left upper eyelid	Same clinical relevance for left upper eyelid entropion.
`D23.2`	Other benign neoplasm of skin of eyelid, including canthus	Excision of benign eyelid tumors may require reconstruction outside standard descriptors, prompting `67999`.
`C44.11`	Basal cell carcinoma of eyelid, including canthus	Malignant eyelid tumor excision with complex reconstruction may lead to use of an unlisted eyelid procedure code.
`H02.831`	Other specified malposition of right eyelid	Atypical malpositions requiring bespoke surgical repair often fall under `67999`.
`H02.832`	Other specified malposition of left eyelid	Same as right-sided malposition for left eyelid procedures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67901`	Repair of entropion, eyelid, without graft; without full-thickness tarsal rotation	May be used for common entropion repairs; `67999` is used when the performed technique is not described by `67901`.
`67902`	Repair of entropion, eyelid, without graft; with full-thickness tarsal rotation	Used for specific entropion techniques; if the surgeon performs a nonstandard or combined reconstructive method not represented by existing codes, `67999` would be reported.
`67906`	Repair of ectropion, eyelid, without graft; lateral canthoplasty or tarsal strip	For standard ectropion repairs; `67999` applies when an unusual or complex eyelid reconstruction is performed.
`67950`	Excision of eyelid lesion including margins, single lesion	For excision of eyelid lesions; if the lesion excision includes atypical reconstruction techniques, `67999` may be appropriate for the reconstructive component.
`12051`	Layer closure of wounds of face, ears, eyelids, nose, and/or lips; 2.6 cm to 7.5 cm	Often used for layered closure of eyelid wounds; `67999` may be billed when the overall eyelid procedure is unlisted rather than a standard closure.
`88305`	Level IV surgical pathology, gross and microscopic examination	Performed when an excised eyelid lesion requires pathology; billed separately and commonly associated with eyelid procedures.

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