CPT 67901
Global 090 ActiveRepair eyelid defect
CPT 67901 Billing & Documentation Guide
CPT code 67901 (Repair eyelid defect) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 7.4, a non-facility practice expense RVU of 15.74, and a malpractice RVU of 0.62, a total non-facility RVU of 23.76 and facility RVU of 15.04. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $818.62, though rates vary from $709.43 to $1043.56 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 67901, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 67901 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 67901 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 67901
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 7.4 | 7.4 |
| Practice Expense RVU | 15.74 | 7.02 |
| Malpractice RVU | 0.62 | 0.62 |
| Total RVU | 23.76 | 15.04 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 67901
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $889.34 | $544.7 | $838.67 - $1043.56 | 29 |
| Florida | $814.96 | $522.74 | $780.89 - $846.82 | 3 |
| Georgia | $773.86 | $496.01 | $740.8 - $806.92 | 2 |
| Illinois | $795.59 | $514.17 | $759.53 - $825.52 | 4 |
| Michigan | $769.97 | $496.49 | $750.54 - $789.41 | 2 |
| North Carolina | $750.91 | $479.16 | $750.91 - $750.91 | 1 |
| New York | $873.54 | $548.62 | $761.17 - $926.53 | 5 |
| Ohio | $748.03 | $482.12 | $748.03 - $748.03 | 1 |
| Pennsylvania | $786.49 | $501.2 | $749.36 - $823.61 | 2 |
| Texas | $785.34 | $498.6 | $744.82 - $822.23 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 67901
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 67901 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0565T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 67901
What does CPT code 67901 mean? +
CPT code 67901 represents: Repair eyelid defect. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 090.
What is the Medicare reimbursement for CPT 67901? +
The 2026 Medicare national average non-facility payment for CPT 67901 is $818.62. Rates range from $709.43 to $1043.56 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 67901? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 67901? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team