How much does Medicare pay for CPT 67904?

Medicare allowed an average of $756.97 per service and paid $597.91 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3751.70, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67904?

Repair of tendon of upper eyelid. It was billed 47,350 times to 34,595 Medicare beneficiaries by 954 providers in 2024.

Does 67904 pay differently in an office than a hospital?

Yes. The allowed amount averaged $962.76 in an office setting and $746.70 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 67904 most?

Ambulatory Surgical Center, with 27,131 services from 403 clinicians. Next are Ophthalmology, Plastic and Reconstructive Surgery, Otolaryngology.

CPT 67904

Repair of tendon of upper eyelid

$756.97Medicare-allowed amount per service, averaged across 47,350 services

Providers submitted

$3751.70

Asking price, not received

Medicare allowed

$756.97

The fee schedule figure

Medicare paid

$597.91

Balance is patient coinsurance

Providers submitted an average of $3751.70 for this code and Medicare allowed $756.97 — 5.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $597.91 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $962.76
Hospital / facility: $746.70

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 2,251 services were billed in an office setting and 45,099 in a facility.

Services: 47,350
Beneficiaries: 34,595
Providers billing it: 954
Total allowed: $35,842,530

What Medicare pays for CPT 67904

Across 47,350 services billed by 954 providers to 34,595 beneficiaries, Medicare allowed an average of $756.97 per service. That is 1.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 67904

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	27,131	14,873	$719.11	403
Ophthalmology	19,474	18,999	$808.68	529
Plastic and Reconstructive Surgery	614	606	$789.15	17
Otolaryngology	131	117	$761.02	5

67904 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	4,014	$733.88	$595.23	64
Florida	3,352	$730.38	$593.94	81
California	3,223	$917.38	$613.31	74
New York	2,588	$757.66	$582.19	34
Pennsylvania	2,322	$766.68	$616.78	52
North Carolina	2,135	$733.52	$612.23	34
Georgia	2,085	$740.16	$608.39	32
Tennessee	1,985	$686.33	$602.37	39
Ohio	1,688	$715.37	$594.34	35
Michigan	1,668	$746.65	$608.91	35
Arizona	1,583	$741.74	$605.85	30
South Carolina	1,480	$730.45	$610.72	27
Virginia	1,384	$737.37	$605.49	24
Washington	1,337	$798.60	$606.84	22
New Jersey	1,311	$797.97	$593.05	23
Mississippi	1,159	$662.25	$594.11	17
Oklahoma	1,065	$716.14	$606.96	18
Indiana	1,030	$743.60	$609.09	16
Illinois	883	$792.35	$621.09	17
Oregon	861	$810.48	$604.41	20
Minnesota	787	$772.25	$602.91	22
Maryland	684	$770.12	$598.49	21
Arkansas	684	$694.81	$602.71	8
Colorado	680	$766.66	$601.65	19
Kentucky	635	$860.63	$728.49	13
Massachusetts	634	$851.86	$601.88	15
Missouri	628	$726.72	$623.90	20
Wisconsin	587	$756.59	$629.90	17
Utah	585	$709.36	$588.56	9
Kansas	503	$734.02	$627.83	14
Nevada	456	$796.39	$614.18	12
Louisiana	443	$712.77	$645.83	12
Alabama	391	$697.55	$618.89	11
Iowa	362	$776.22	$747.36	11
Nebraska	296	$738.46	$631.02	6
Idaho	262	$700.10	$600.22	9
South Dakota	254	$731.26	$608.68	5
New Mexico	227	$757.59	$627.17	2
North Dakota	183	$741.90	$615.01	5
Connecticut	181	$822.15	$598.69	6
Maine	155	$646.49	$539.01	4
Hawaii	139	$884.27	$613.64	5
New Hampshire	101	$745.76	$610.81	4
District of Columbia	79	$916.35	$634.65	2
West Virginia	73	$790.47	$677.90	2
Montana	65	$750.55	$612.59	2
Puerto Rico	59	$582.60	$593.03	2
Delaware	41	$807.82	$611.52	1
Vermont	23	$811.95	$653.23	1

Related codes

67917Extensive repair of turning-outward eyelid defect$572.32
67900Repair of brow paralysis$549.88
67908Removal of tissue$669.86
67903Shortening or advancement of upper eyelid muscle to correct drooping o$672.04
67950Reconstruction of eyelid margin$489.92
67924Extensive repair of turning-inward eyelid defect$625.44
67966Removal of over 1/4 of eyelid margin and repair of eyelid$684.96
67938Removal of embedded foreign body in eyelid$316.68
67961Removal of up to 1/4 of eyelid margin and repair of eyelid$560.01
67911Correction of widely-opened upper eyelid$512.98

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.