CPT code 67820: trichiasis epilation billing and reimbursement

CPT code 67820 is the procedure code for correction of trichiasis by epilation using forceps only. It covers the removal of misdirected eyelashes that scrape the cornea or conjunctiva.

The code carries a 0-day global period, so a repeat session is billable whenever the record supports it. Medicare pays roughly $41.75 to $41.96 for it in a non-facility office in 2026.

Bill it with modifier -50 when both eyes are treated in one session. Pair it with an H02.05x diagnosis that matches the documented laterality. The sections below cover modifiers, the RVU breakdown, frequency limits, documentation, and the denials this code attracts.

Found our content helpful?

Key takeaways

CPT code 67820 covers correction of trichiasis by epilation with forceps only, not electrosurgery, cryotherapy, or laser.

The code has a 0-day global period, so each medically necessary session can be billed again.

Modifier -50 applies when both eyes are treated in one session, and Medicare then pays 150% of the allowed amount.

The diagnosis codes that pair with 67820 are the H02.05x trichiasis series, reported by documented laterality.

Practice management software like Pabau passes the diagnosis and modifier already documented in the record through to the claim.

CPT code 67820: official descriptor and clinical context

CPT code 67820 sits in the Excision and Destruction subsection of Eye and Ocular Adnexa procedures. That subsection belongs to the AMA CPT code set. Its official descriptor is: Correction of trichiasis; epilation, by forceps only.

Trichiasis is a condition in which eyelashes grow in an abnormal direction, contacting the cornea or conjunctiva. Left untreated, it causes persistent irritation, corneal abrasion, and in severe cases, ulceration and vision loss. Epilation using forceps is the most basic intervention, physically removing the offending lashes. Because the hair follicle remains intact, lashes regrow, making repeat procedures medically necessary for most patients.

The code applies exclusively to the forceps technique. If a more definitive method is used, such as electrosurgical epilation, cryotherapy, or laser ablation, a different CPT code is required. This distinction is one of the most frequent sources of upcoding audit risk for practices that perform multiple trichiasis correction techniques.

Related CPT codes for trichiasis and eyelid procedures

CPT code 67820 sits within a family of trichiasis correction codes. Selecting the wrong code, particularly when a more invasive procedure was performed, can result in underpayment or a compliance issue. The table below covers the key adjacent codes and when each applies.

Practices that bill several trichiasis techniques should confirm the note names the method before anyone picks a code. A chart note reading “lashes removed” leaves the choice open to payer interpretation.

Eyelid work outside this family follows its own rules. An excision of an eyelid lesion is coded as 67840, chosen from the lesion rather than from the lashes.

ICD-10 codes linked to CPT 67820

Medical necessity for CPT code 67820 requires pairing with a valid ICD-10-CM diagnosis code that supports the clinical indication. The primary diagnosis family is H02.05x, covering trichiasis of the eyelid with and without entropion, specified by laterality. Laterality specificity is required. Submitting an unspecified code when the record documents a specific eye can trigger a denial.

When trichiasis is caused by an underlying entropion, report the entropion code on its own. The H02.00 to H02.04 entropion subcategories already include trichiasis caused by entropion, so a second trichiasis code adds nothing to the claim.

Check validity before the claim goes out, because the H02 family shifts with each fiscal year. The CMS ICD-10 code files carry the current tabular list. Our ICD-10-CM code index covers the eyelid codes in the same detail as this page.

Modifiers for CPT 67820

Correct modifier use is critical for CPT code 67820, particularly because trichiasis frequently presents bilaterally and because eyelid laterality modifiers are required by many payers. The table below covers the modifiers most commonly applied to this code.

Bilateral billing for CPT 67820

When CPT code 67820 is performed bilaterally in the same session, apply modifier -50 to the single claim line. CMS Medicare Physician Fee Schedule rules assign every code a bilateral surgery indicator. Where that indicator is 1, Medicare pays 150% of the allowed amount when modifier -50 is used. Verify the current bilateral surgery indicator for 67820 in the MPFS database before billing.

• Bill a single line with 67820-50 (do not bill two separate lines for each eye unless your payer specifically requires it)
• Price the claim at the single-procedure allowed amount, then let the payer apply the 150% adjustment
• Commercial payers may handle bilateral billing differently (some require two lines with -RT and -LT rather than -50; confirm payer policy)
• Document both eyes treated in the encounter note, specifying which lids on each eye were treated

Medicare reimbursement and 2026 fee schedule for CPT 67820

Reimbursement for CPT code 67820 comes from the Medicare Physician Fee Schedule. The calculation is relative value units (RVUs) multiplied by the annual conversion factor. CY2026 carries two conversion factors, $33.5675 for qualifying alternative payment model participants and $33.4009 for everyone else.

The rates below are unadjusted, so your payment moves with your locality’s Geographic Practice Cost Index (GPCI). Verify the current figure in the CMS fee schedule search before you quote a price to a patient.

RVU breakdown for CPT 67820

Practice expense is what separates the two settings. The office keeps 0.58 practice expense RVUs and the facility keeps 0.18, which is where the difference in payment comes from.

Non-facility rates apply when the procedure is performed in a private ophthalmology office. Facility rates apply in a hospital outpatient department or an ambulatory surgery center. Confirming the place of service code on the claim is what keeps the two apart.

How often can CPT 67820 be billed?

CPT code 67820 can be billed each time the procedure is medically necessary. Because forceps epilation does not destroy the hair follicle, lashes reliably regrow, and many patients require repeat treatment every four to eight weeks. The American Academy of Ophthalmology’s coding guidance supports repeated billing as long as medical necessity is documented at each encounter.

That said, individual Medicare Administrative Contractors (MACs) may impose frequency limitations through Local Coverage Determinations. Some MACs have policies limiting the number of billable epilation sessions per eye per rolling period without additional supporting documentation. Before establishing a regular epilation schedule for a patient, check your MAC’s active LCDs for CPT 67820 and any applicable National Coverage Determinations.

• Document fresh medical necessity at every encounter, not by reference to a prior note
• Record the specific lids treated and the number of lashes removed
• Note any corneal involvement, foreign body sensation, or vision change that supports medical necessity
• If billing more than once per month, ensure your notes show recurrence, not routine maintenance

Documentation requirements for CPT 67820

Complete chart documentation is the strongest defense against denied claims and audit recovery demands for CPT code 67820. The record has to support both the diagnosis and the specific technique used. A note reading “lashes removed” establishes neither technique, laterality, nor medical necessity.

Each encounter note should include all of the following:

• Diagnosis of trichiasis with the specific ICD-10-CM code confirmed in the assessment
• Laterality: which eye (right, left, or bilateral) and which eyelid (upper, lower, or both)
• Technique: explicit statement that epilation was performed by forceps (not electrosurgery or laser)
• Number of lashes removed or the clinical description of lash involvement
• Medical necessity statement: how the misdirected lashes are affecting the patient (corneal contact, irritation, tearing, abrasion)
• Provider credentials: licensed and credentialed for the procedure

The documentation has to be complete before the claim is generated, not repaired after a denial arrives. Structured note templates that prompt for each required field during the visit beat asking a coder to interpret free text weeks later.

Common billing errors for CPT 67820 and how to avoid them

Most claim denials for CPT code 67820 come from a short list of avoidable errors. Catching them before submission costs far less than working the denial after the explanation of benefits arrives.

• Wrong code for technique used. Using 67820 when electrosurgical epilation (67825) was performed. If the clinical note says “electrolysis” or “electrosurgery,” 67820 is incorrect.
• Missing modifier. Omitting -RT or -LT for unilateral procedures, or failing to use -50 for bilateral, causes laterality-related denials on many Medicare Advantage and commercial plans.
• Unspecified ICD-10-CM code. Submitting H02.059 when the record clearly documents the right upper lid. Payers that require specificity will deny or downcode.
• Insufficient medical necessity documentation. Notes that reference only “patient complaint of eye irritation” without tying it to the misdirected lashes give reviewers grounds to deny as not medically necessary.
• Billing over the MAC frequency limit without additional documentation. If your MAC allows four sessions per eye per year under the LCD, a fifth session requires supporting documentation that goes beyond a routine note.
• Place of service mismatch. Submitting with a non-facility place of service code when the procedure was performed in a facility setting. This inflates the claimed amount and flags for recovery.

Running a pre-submission claim scrub against National Correct Coding Initiative (NCCI) edits catches the most common pairing and modifier errors. Refer to the AAPC CPT code reference for current NCCI companion code edits applicable to 67820.

How practice management software simplifies CPT 67820 billing

Trichiasis epilation is a high-frequency, low-complexity procedure. That combination is where quiet billing errors accumulate. A missing modifier, an unspecified ICD-10 code, or an unchecked place of service can repeat across dozens of claims before a payer audit surfaces it.

Pabau, practice management software for medical and aesthetic practices, integrates with Claim.MD, our US clearinghouse partner. That route covers eligibility verification, NCCI edit checks, and 837P submission to thousands of payers.

For an ophthalmology practice billing 67820 every few weeks, each session generates a claim from the structured encounter record. It passes the diagnosis, modifier, and place of service already documented there through to the payer, with no transcription step in between.

Pabau’s cleaner claims management also tracks electronic remittance advice and 835 remittance files. Denial patterns for one CPT code then surface in the dashboard instead of staying buried in individual remittances.

• Real-time eligibility verification before each epilation session
• The diagnosis and modifier documented at the visit carried through to the claim
• Pre-submission NCCI edit scrubbing for modifier conflicts
• ERA and remittance tracking for denial pattern analysis
• Superbill generation aligned to the structured encounter record

A practice still working from a superbill can export a CMS-1500 aligned version straight from the encounter, pre-populated with the codes in the clinical note. That suits a practice not yet ready for fully automated submission.

Either way, the transcription step where laterality and specificity errors start is removed from the process.

Keep repeat 67820 claims moving

Pabau links the clinical note to the claim, so the diagnosis, modifier, and place of service documented at the visit reach the payer unchanged.

Book a demo

Conclusion

Trichiasis epilation is a small procedure with an exacting claim. The technique in the note has to match the code. The modifier has to match the eyelid treated, and the diagnosis has to carry the same laterality.

Because the follicle survives the procedure, the same patient returns, and any error in that first claim returns with them. Rewriting the note template once is worth more than appealing the denials one at a time.

Decide where the billing detail gets captured, then hold the workflow to it. Book a demo to see how Pabau keeps repeat 67820 claims consistent from the encounter note through to the remittance.

Continue your research

Need to understand how claim denials are categorized and appealed? Denial management in healthcare covers the full denial workflow from reason code identification through resubmission.

Billing eye exams alongside minor eyelid procedures? CPT code 92012 sets out the four elements an intermediate eye exam has to document before it can be billed.

Coding another eyelid procedure this week? CPT code 67840 explains how eyelid lesion excision is coded and where its two exclusions sit.

Want to understand how electronic claim files work end to end? 837 claim file guide explains the EDI 837P format used to submit professional claims to Medicare and commercial payers.

Frequently asked questions