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See a sample rate comparisonCPT 67961 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.
Revision Of Eyelid, Excision And Repair Of Eyelid Involving Lid Margin Tarsus Conjunctiva Canthus Or Full Thickness May Include Preparation For Skin Graft Or Pedicle Flap With Adjacent Tissue Transfer Or Rearrangement Up To One Fourth Of Lid Margin
| 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 E2 - Lower left, eyelid E4 - Lower right, eyelid |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 67961 |
| Medicaid Fee Schedule | View Medicaid rates for 67961 |
National average reimbursement for CPT 67961 by major payers:
$713.47
$748.04
$801.04
$918.80
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CPT 67961
5 of 25 sample ratesHigher to lower in this preview
Baylor Surgicare At Baylor Plano, LLC, Baylor Scott & White Surgicare At Plano Alliance
Baylor Surgicare At Baylor Plano LLC
$3,150.00Published rateAllegheny Clinic
Highmark Health
$2,045.00Published rateSerenity Surgical, LLC
$1,500.00Published rateLiz Rodriguez
Deaconess Hospital Inc
$1,024.58Published rateGastroenterology Consultants Of Tuscaloosa Inc, Tuscaloosa Endoscopy Center
$100.00Published rate
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See a sample payer proposalCPT 67961 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67961 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 67961 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 |
|---|---|---|
| 67915-CPT | Moderate | Repair Eyelid Position, Surgery To Correct The Lower Eyelid Position So That It No Longer Turns Outward Or Sags (Ectropion). |
| 67916-CPT | Moderate | Repair Eyelid Position, Surgery To Correct The Lower Eyelid Position So That It No Longer Turns Outward Or Sags (Ectropion). |
| 67917-CPT | Moderate | Repair Of Ectropion Blepharop, Repair Of Ectropion Blepharoplasty Extensive (Egkuhnt-Szymanowski Or Tarsal Strip Operations) |
| 67961-CPT | Moderate | Revision Of Eyelid, Excision And Repair Of Eyelid Involving Lid Margin Tarsus Conjunctiva Canthus Or Full Thickness May Include Preparation For Skin Graft Or Pedicle Flap With Adjacent Tissue Transfer Or Rearrangement Up To One Fourth Of Lid Margin |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67961. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67961 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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