CPT Code 67900: Repair of Brow Ptosis (Supraciliary, Mid-Forehead, or Direct)

What is brow ptosis repair?

The 67900 CPT code refers to the surgical procedure used to correct brow ptosis, a condition in which the brow droops, contributing to upper eyelid ptosis or upper eyelid drooping. This condition often leads to visual field impairment and functional visual impairment, making brow ptosis repair medically necessary in many cases.

Unlike upper eyelid blepharoplasty and eyelid surgery, which target excess upper eyelid skin, this procedure lifts the forehead muscles or brow to relieve pressure on the upper eyelid margin and improve upper visual field function.

CPT code 67900 is typically used when the drooping brow compromises visual field-related activities or contributes to peripheral vision loss. Plastic surgeons may perform this in the same surgical session as an upper lid blepharoplasty or ptosis repair to optimize results and improve beneficial functional outcomes.

Techniques may include the frontalis muscle technique, levator resection, or autologous fascial sling, depending on the patient’s anatomy and severity of eyelid ptosis.

When billed under the Medicare physician fee schedule, this procedure must meet local coverage determination criteria and show visual field testing evidence of superior visual field loss. Accurate documentation ensures the procedure is considered reasonable and medically necessary by Medicaid services and other payers.

Documentation requirements

To support medical necessity for CPT code 67900, documentation must clearly show that the brow ptosis is causing a functional impairment. Include the following details:

• Clinical indication, such as documented superior visual field loss due to brow descent
• Preoperative visual field testing showing the impairment, along with photographs demonstrating brow drooping
• Manual elevation test results, if available, showing improvement in visual fields when the brow is lifted
• Surgical approach used (e.g., direct, mid-forehead, or supraciliary), including incision location, tissue removed, and fixation method
• Postoperative assessment, noting patient outcome and any complications if applicable

Payers—particularly Medicare—typically require objective proof, including visual field data and photographic evidence, to determine that the procedure is medically necessary and not cosmetic.

Billing guidelines

• Use CPT 67900 when the brow itself is surgically repositioned, not when addressing the eyelid (which is covered under blepharoplasty codes like 15822–15823).
• May be billed bilaterally using modifier -50 or RT/LT, depending on payer-specific guidelines.
• Prior authorization is often required, especially when the procedure is not related to trauma or documented functional impairment.
• This code is distinct from blepharoplasty, which involves upper or lower eyelid tissue, not the brow.
• Cosmetic brow lift procedures are not reimbursed by most payers, including Medicare. Documentation must show medical necessity to qualify for coverage.

Other relevant CPT codes

• 15822/15823 – Blepharoplasty
• 67904 – Repair of blepharoptosis, external approach
• 15820 – Forehead lift for cosmetic indications