67917

👁️ CPT 67917 — Repair of Ptosis, Eyelid; With Levator Resection

Quick Reference

wRVU: 7.42 | Global Period: 090 (90 days) | Assistant Payable: ❌ No | Bilateral Indicator: 1

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📋 Clinical Description

CPT 67917 describes the surgical correction of blepharoptosis (drooping eyelid) specifically through the resection (shortening) of the levator palpebrae superioris muscle. The procedure involves accessing the levator muscle, removing a segment of the muscle or its aponeurosis, and re-anchoring it to create a tighter “sling” that lifts the eyelid margin higher upon contraction. This code is distinct from 67911 (Müller’s muscle resection), which is used for mild ptosis, and 67904 (frontal sinus approach), which is a more invasive procedure for severe ptosis.

Blepharoptosis H02.4x is the abnormal lowering of the upper eyelid margin. It can be congenital (due to poor development of the levator muscle) or acquired (due to aponeurotic stretching, nerve palsy, or myogenic diseases like Myasthenia Gravis). If untreated, severe ptosis can obstruct the visual axis, leading to visual field loss or amblyopia in children.

This procedure may be performed in the following clinical contexts:

• Aponeurotic Ptosis — The most common form in adults, where the levator tendon detaches or stretches.
• Congenital Ptosis — When the levator muscle is poorly developed, requiring significant resection to achieve lift.
• Myogenic Ptosis — Ptosis resulting from muscle weakness, where resection is used to optimize the remaining muscle function.
• Post-Traumatic Ptosis — Repair of the levator mechanism following eyelid injury or previous surgery.
• Severe Ptosis requiring significant lift — When the eyelid drop is too great for a simple Müller’s muscle resection 67911.

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🔬 Anatomical & Procedural Considerations

Modality	Approach	Key Feature
External Approach	Skin incision at the eyelid crease	Standard approach allowing direct visualization of the levator aponeurosis.
Internal Approach	Conjunctival/Transconjunctival	Less common for levator resection; typically used for Müller’s muscle procedures.
Levator Resection	Muscle shortening	The levator muscle is folded or a segment is excised to increase the vertical pull on the tarsal plate.

Clinical Pearl

The key differentiator between 67917 and 67911 is the structure being operated on. If the operative note specifies “levator aponeurosis” or “levator muscle,” use 67917. If it specifies “Müller’s muscle” or “posterior lamella,” use 67911. Documentation must explicitly state the muscle resected to survive an audit.

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✅ Procedure Includes

• Pre-procedure marking of the desired eyelid height.
• Local anesthesia infiltration (lidocaine with epinephrine).
• Skin incision and dissection to expose the levator aponeurosis.
• Identification and isolation of the levator muscle.
• Resection (shortening) of the muscle/aponeurosis.
• Suturing the muscle to the tarsal plate.
• Skin closure and post-operative dressing.

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❌ Excludes / Do Not Report Together

Code	Description	Relationship to 67917
67911	Repair of ptosis; with Müller’s muscle resection	Mutually exclusive; 67917 is for the levator muscle, 67911 is for the smaller Müller’s muscle.
67904	Repair of ptosis; frontal sinus approach	More extensive procedure; subsumes the need for simple levator resection if performed.
15823	Blepharoplasty, upper eyelid	Often performed concurrently, but usually separately reportable if the ptosis repair is a distinct medical necessity.
E/M codes (992xx)	Office visit, any level	Separately reportable only when modifier -25 is appended to the E/M code.

Bundling Alert — Global Period is 090, Not 010

This is a major surgical procedure with a 90-day global window. All routine post-operative visits (suture removal, height checks) are bundled. If the patient returns for an unrelated issue (e.g., a cold or a different eye condition), modifier -24 must be appended to the E/M code.

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🌳 Code Tree — Surgery: Eyelids

CPT 67800-67999  Surgery: Eyelids, Conjunctiva, Cornea, and Ocular Adnexa
│
├── 67800-67850  Excision and Destruction (Eyelid)
│
├── 67900-67917  Repair of Ptosis
│   ├── 67900  Repair of ptosis; with frontal sinus approach
│   ├── 67904  Repair of ptosis; with frontal sinus approach, with muscle transposition
│   ├── 67911  Repair of ptosis; with Müller's muscle resection (Global: 090)
│   ├── ▶▶ 67917 ◀◀  Repair of ptosis; with levator resection  ← YOU ARE HERE  (Global: 090)
│
└── 67920-67940  Other Eyelid Repairs

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💰 RVU & Reimbursement Profile

Component	Value
Work RVU (wRVU)	7.42 (verify against current CMS MPFS)
Global Period	090 (90 days)
Bilateral Indicator	1 — Subject to standard bilateral reduction rules.
Assistant Surgeon	❌ Not payable
Co-Surgeon	❌ Not applicable
Team Surgery	❌ Not applicable
PC/TC Split	❌ No — procedure code only (Indicator 0)
Modifier -51 Exempt	No
Anesthesia	Local infiltration; no separate anesthesia billing expected.

Bilateral Billing Rules

67917 has a bilateral indicator of 1. When performed on both eyes in the same session, the preferred billing is a single line with modifier -50. Medicare typically pays 150% of the single-procedure rate (100% for the first eye, 50% for the second).

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🏷️ Modifier Reference

Modifier	Name	When to Apply
-RT	Right Side	Procedure performed on the right upper eyelid.
-LT	Left Side	Procedure performed on the left upper eyelid.
-50	Bilateral Procedure	Both eyelids repaired in the same session.
-25	Significant, Separately Identifiable E/M	Applied to the E/M code when a separate evaluation is performed on the day of surgery.
-24	Unrelated E/M During Postoperative Period	Applied to the E/M code for visits within the 90-day window for unrelated conditions.
-51	Multiple Procedures	When 67917 is the secondary procedure in a session.
-59	Distinct Procedural Service	Used if performing a ptosis repair and another eyelid procedure (like a blepharoplasty) that is not bundled.

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🩺 Common ICD-10-CM Pairings

Blepharoptosis (Primary Diagnosis)

ICD-10 Code	Description	HCC?	Clinical Notes
H02.41	Blepharoptosis of right upper eyelid	❌ No	Most specific code for right-sided ptosis.
H02.42	Blepharoptosis of left upper eyelid	❌ No	Most specific code for left-sided ptosis.
H02.43	Blepharoptosis of bilateral upper eyelids	❌ No	Use when both eyes are treated.
H02.40	Blepharoptosis, unspecified eye	❌ No	Avoid; query provider for laterality.

Etiology and Associated Conditions

ICD-10 Code	Description	HCC?	Clinical Notes
Q10.1	Congenital ptosis	❌ No	Supports medical necessity for pediatric cases.
G12.21	Myasthenia gravis	✅ HCC	High-complexity etiology; supports medical necessity for specialized repair.

Coding Specificity Reminder

The most common gap is failing to specify laterality (Right vs. Left vs. Bilateral). Always ensure the operative note explicitly states which eye(s) were operated on to avoid using the unspecified code H02.40.

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🏥 MS-DRG Considerations (Inpatient)

Inpatient Coding Reminder

CPT 67917 is performed primarily in the outpatient / office / ASC setting. There are no routine MS-DRG assignments for this procedure — inpatient admission for ptosis repair would not be supported by any payer.

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🔧 ICD-10-PCS Equivalents (Inpatient Facility Coding)

Note

Inpatient PCS coding for ptosis repair is rare. If performed during a larger inpatient stay, the root operation is typically “Repair.”

PCS Code	Full Description	Applicable Modality
0HP10ZZ	Repair Upper Eyelid, Right, Open Approach	Levator Resection
0HP10ZZ	Repair Upper Eyelid, Left, Open Approach	Levator Resection

PCS Character Analysis — 0HP10ZZ

Position	Character	Value	Definition
1	Section	0	Medical and Surgical
2	Body System	H	Eye
3	Root Operation	P	Repair (Restoring function of a body part)
4	Body Part	1	Upper Eyelid
5	Approach	0	Open
6	Device	Z	No Device
7	Qualifier	Z	No Qualifier

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📝 Coding Examples

Example 1 — ASC: Unilateral Aponeurotic Ptosis

Clinical Scenario: A 65-year-old male presents with severe drooping of the right upper eyelid. The surgeon performs a right upper eyelid levator resection via an external skin incision. The operative note states: “A 4mm segment of the levator aponeurosis was resected and the muscle was secured to the tarsal plate.” No separate E/M was billed.

Field	Code	Rationale
CPT	67917-RT	Levator resection performed on the right side.
PDx	H02.41	Blepharoptosis of right upper eyelid.

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Example 2 — Office: Bilateral Congenital Ptosis

Clinical Scenario: A 4-year-old female is seen for bilateral congenital ptosis. The surgeon performs bilateral levator resections under sedation in the office. The note documents “bilateral levator muscle shortening.” A separate E/M was performed earlier that morning to discuss risks and benefits.

Field	Code	Rationale
CPT 1	67917-50	Bilateral levator resection.
CPT 2	99213-25	Separate E/M for surgical consent and final pre-op check.
PDx	Q10.1	Congenital ptosis.
SDx	H02.43	Bilateral blepharoptosis.

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⚠️ Common Coding Pitfalls

• Confusing Levator vs. Müller’s: Billing 67917 when the surgeon actually performed a Müller’s muscle resection. This results in overcoding as 67917 has a higher wRVU.
• Missing Laterality: Using H02.40 (unspecified) instead of H02.41 or H02.42, which often triggers a payer denial or a request for more information.
• Incorrect Global Period: Treating the procedure as a “minor” surgery (10-day global) instead of a “major” surgery (90-day global), leading to improper billing of follow-up visits.
• Billing -25 without Documentation: Appending modifier -25 to an E/M code without documenting a “significant, separately identifiable” service beyond the routine pre-operative assessment.

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📎 Sources

^{AMA CPT 2025 Professional Edition} · ^{CMS 2025 Medicare Physician Fee Schedule Final Rule} · ^{ICD-10-CM Official Guidelines FY2025} · ^{AAO (American Academy of Ophthalmology) Coding Guidelines}