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See a sample rate comparisonCPT 67904 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Rpair Of Blepharoptosis; (Tarso) Levator Resct Or Advancem Ex, Repair Of Blepharoptosis; (Tarso) Levator Resection Or Advancement Ex
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 24 - Ambulatory Surgical Center 11 - Office |
| Common Modifiers | None 50 - Bilateral Procedure LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 67904 |
| Medicaid Fee Schedule | View Medicaid rates for 67904 |
National average reimbursement for CPT 67904 by major payers:
$893.35
$942.96
$1,022.90
$1,156.69
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CPT 67904
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Katy LLP
$5,048.00Published rateAndrews Institute Asc LLC
Andrews Institute Asc, LLC
$2,056.00Published rateEye Mds Of Puget Sound PLLC, Narrows Eye Surgery Center
Eye M.D.S Of Puget Sound, PLLC
$1,450.00Published rateOakwood Surgery Center, Ltd., LLP
Oakwood Surgery Center Ltd LLP
$1,100.00Published rateSurgicare Of Mobile Ltd
$743.00Published rate
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See a sample payer proposalCPT 67904 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67904 code is part of the Surgery services used for Surgical Procedures on the Eye and Ocular Adnexa. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 67904 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 67900-CPT | Moderate | Rpair Of Brow Ptosis (Suprciliary Mid-Forehead Or Coronal Approa, Repair Of Brow Ptosis (Supraciliary Mid-Forehead Or Coronal Approach) |
| 67901-CPT | Moderate | Rpair Of Blepharoptosis; Frontalis Muscl Techniq W/ Suture Or Ot, Repair Of Blepharoptosis; Frontalis Muscle Technique With Suture Or Ot |
| 67902-CPT | Moderate | Rpair Of Blepharoptosis; Frontalis Muscl Techniq W/ Autologous F, Repair Of Blepharoptosis; Frontalis Muscle Technique With Autologous F |
| 67904-CPT | Moderate | Rpair Of Blepharoptosis; (Tarso) Levator Resct Or Advancem Ex, Repair Of Blepharoptosis; (Tarso) Levator Resection Or Advancement Ex |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67904. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67904 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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