CPT code 67924 – Extensive entropion repair

Key takeaways

CPT code 67924 covers extensive entropion repair, such as a tarsal strip or capsulopalpebral fascia repair, and sits at the top of the 67921-67924 family.

Suture repair (67921), thermocauterization (67922) and tarsal wedge excision (67923) have their own codes, so the operative report must name the extensive technique.

Every claim needs a specific H02.0- entropion code that names the eye and the lid. Unspecified codes invite manual review or denial.

The 90-day global period applies, and the eyelid modifiers E1-E4 identify the lid treated. Confirm -RT, -LT and bilateral -50 rules with each payer.

Pabau, the practice software we build, submits US claims through Claim.MD and tracks prior authorizations on each case. Practices can set up workflow checks for eyelid modifiers and ICD-10 pairing.

CPT code 67924: Official descriptor and procedure overview

CPT code 67924 is the code for repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation).

UnitedHealthcare’s 2026 Medicare Advantage eyelid policy lists 67924 with that descriptor, beside 67921-67923 for the suture, cautery and tarsal wedge repairs. The code set itself is maintained by the American Medical Association’s CPT Editorial Panel.

Entropion is an eyelid malposition in which the lid margin rotates inward, so the lashes rub against the cornea. Left untreated, it leads to corneal erosion, chronic epiphora, recurrent conjunctivitis and, in severe cases, corneal scarring.

The “extensive” qualifier separates 67924 from the simpler repairs in the same family. It applies when the surgeon tightens or reattaches the lid’s supporting structures, as in a lateral tarsal strip or a lower lid retractor repair. Oculoplastic surgeons and ophthalmologists usually perform it under local anesthesia, in an office, an ambulatory surgery center or a hospital outpatient department.

What CPT 67924 includes and excludes

CPT code 67924 covers extensive entropion repair, where the surgeon corrects the lid position by tightening or reattaching its supporting structures. The descriptor names tarsal strip and capsulopalpebral fascia repair as examples.

Included under 67924: Lateral tarsal strip procedures, capsulopalpebral fascia (lower lid retractor) repair, and comparable extensive reconstruction that repositions the lid margin.

Not included: Suture repair (67921), thermocauterization (67922) and excision of a tarsal wedge (67923) each have their own code. Blepharoplasty codes (15820-15823) are billed separately only for a distinct anatomical site with its own medical necessity documentation. Billing 67924 with blepharoplasty on the same lid in the same session, without documented separate indications, triggers National Correct Coding Initiative (NCCI) edit denials.

Ptosis repair codes in the 67900-67908 range, such as 67904, are not routinely bundled with 67924. If both conditions are repaired on the same eye in one session, document a distinct surgical goal for each repair.

CPT 67924 vs 67921, 67922, and 67923: Choosing the right code

The 67921-67924 family is a complexity ladder, and each code maps to one technique. Upcoding to 67924 without operative documentation of an extensive technique is an audit risk. The ladder below matches the wording in the operative note to the code it supports.

The table adds the relative complexity and a typical use case for each code in the family.

The operative report is the deciding document. If it describes sutures, cautery or a tarsal wedge excision without a tarsal strip or retractor repair, 67924 is not supportable, whatever the surgeon intended.

ICD-10 diagnosis codes to pair with CPT 67924

Entropion is classified under ICD-10-CM category H02.0, with subcategories for type, eye and eyelid. Pair CPT code 67924 with the most specific code available. Most payers, including Medicare, require full 6-character specificity to process the claim without extra review. Billing H02.009 (unspecified entropion of unspecified eye, unspecified eyelid) when the operative report names the eye and type triggers manual review and often denial.

Verify current-year ICD-10-CM specificity requirements using the CDC/NCHS ICD-10-CM web tool. Code descriptions and subcategory structures are updated annually each October.

Medicare reimbursement rates for CPT code 67924

Medicare pays CPT code 67924 through the Medicare Physician Fee Schedule (MPFS), and the amount varies by setting and location. The figures below are 2026 national values from CMS’s relative value file, as listed in FastRVU’s 67924 entry. Your Medicare Administrative Contractor (MAC) adjusts them with geographic practice cost indices (GPCIs).

Confirm the current-year figures in the CMS Physician Fee Schedule lookup tool before you quote or post them. The non-facility rate is higher because the practice carries the equipment and staff cost. In an ASC or hospital, the facility bills its own fee and the surgeon is paid at the lower facility rate.

Medical necessity requirements for entropion repair

A cosmetic-versus-functional determination drives many CPT code 67924 denials. Medicare has no national coverage determination for entropion repair, so each MAC’s Local Coverage Determination (LCD) sets the criteria. Medicare and most commercial payers cover the repair only when the record shows the inward lid causing corneal or conjunctival pathology.

Documentation that supports medical necessity typically includes all of the following, subject to individual MAC billing compliance requirements and LCDs:

• Documented symptoms: Corneal erosion, recurrent corneal abrasion, epiphora (excessive tearing), or recurrent conjunctivitis attributable to lash-corneal contact
• Failed conservative management: A trial of lubricating eye drops, lid taping, or other non-surgical measures, documented with dates and outcomes
• Slit-lamp or clinical photographs confirming the lid malposition and corneal involvement
• Physician attestation that repair is for a functional indication, not cosmetic improvement
• ICD-10-CM diagnosis code with laterality specificity matching the operative site

Some MACs publish specific LCDs for eyelid surgery. Check the relevant MAC website for your practice’s jurisdiction before submitting claims involving CPT code 67924.

Modifiers for CPT code 67924

Modifier selection decides whether a 67924 claim pays in full, pays at a reduced rate or stops for manual review. A wrong or missing modifier is a frequent cause of denial in this code family.

Where the payer allows bilateral payment, modifier -50 pays 150% of the single-side rate rather than two full payments. Each eye must meet medical necessity criteria on its own, so document the symptoms and findings for both.

Global surgery period and post-op billing rules

CPT code 67924 carries a 90-day global surgery period under CMS policy. Routine post-operative visits related to the entropion repair are bundled into the surgical fee and cannot be billed separately during that window.

• Bundled (not separately billable during global period): Routine post-op check at 1 week, lid suture removal, standard healing assessment visits
• Separately billable with modifier -24: An E/M visit for a new, unrelated condition, such as an upper respiratory infection. The note must show that the visit did not address the surgical site
• Separately billable with modifier -78: Return to the operating room during the global period to manage a complication directly related to the entropion repair
• Separately billable with modifier -79: An unrelated surgical procedure during the global period with distinct documentation of a separate indication

For a 90-day global code, Medicare’s package runs from the day before surgery through 90 days after it. It covers the surgeon’s professional services, while an ASC or hospital bills its facility fee separately. Document the reason for any separately billed service in this window, and append the right modifier to every claim line that falls outside the package.

Common claim denials for CPT 67924 and how to prevent them

Denials on CPT code 67924 claims tend to repeat the same few causes, and most can be caught before submission with structured denial management workflows. When one does come back, the remittance names the reason with a code, and our list of medical billing denial codes explains each one. The table below maps the frequent reasons to their root causes and prevention actions.

Documentation requirements for CPT 67924

The operative report is the primary audit document for CPT code 67924 claims. Payer post-payment audits for eyelid surgery frequently request the op report along with pre-operative clinical notes and photographs. A well-structured report makes the difference between a clean approval and a full repayment demand.

The operative report must address each of these elements to support 67924 and satisfy a clean claim submission:

• Specific technique performed, naming the procedure (for example, lateral tarsal strip or capsulopalpebral fascia reinsertion) rather than generic language like “lid repair”
• Laterality: Which lid (upper or lower) and which eye (right or left) was treated
• Pre-operative diagnosis with the specific ICD-10-CM code and clinical rationale
• Extent of tissue involvement: Description of the lid tightening, retractor repair or structural alteration performed
• Photographs or slit-lamp documentation referenced in the note or attached to the record
• Consent language or attestation confirming the functional (not cosmetic) indication for surgery
• Post-operative plan specifying follow-up interval within the global period

A standard operative note template for the entropion repair family puts each of these elements in front of the surgeon before the chart is closed. It also gives coders the same layout to check on every 67924 claim.

Prior authorization and payer-specific policies

Traditional Medicare does not routinely require prior authorization for CPT code 67924, but authorization requirements vary significantly across Medicare Advantage plans and commercial payers. Skipping the authorization check is the most avoidable denial in this family.

• Medicare Advantage: Many plans require prior auth for eyelid surgery; submit the clinical note, photographs, and ICD-10-CM code with the auth request
• Commercial insurers: Policies differ by plan; check the payer portal or call the provider line before the procedure date
• Medicaid: State programs vary; some require auth, others rely on post-payment review under LCD criteria
• Documentation to submit with auth requests: The ICD-10 diagnosis, a letter of medical necessity, photos of the lid malposition, and proof of failed conservative treatment

Find your practice’s MAC and its published LCD for eyelid surgery in the CMS Medicare Coverage Database. MACs including Noridian, Novitas, and CGS publish specific coverage criteria that define what constitutes sufficient medical necessity for functional eyelid procedures.

How practice management software simplifies CPT 67924 billing

A practice billing CPT code 67924 has five details to get right on every claim. They are the code within the family, the eyelid modifier, a specific H02.0- diagnosis, any prior authorization and the 90-day global period. Pabau, the practice management platform we build, includes claims management software that keeps the claim, the case and the authorization in one record.

In the US, Pabau submits CMS-1500/837P claims through the Claim.MD clearinghouse, with eligibility checks, ERA remittances and secondary claims. Prior authorization codes, dates and sessions are tracked on the case, with a warning when one is missing. For a Medicare Advantage patient booked for 67924, the front desk sees that warning before surgery rather than after a denial.

Practices can also set up workflow checks for 67924 claims that lack a paired H02.0- diagnosis or an eyelid modifier. The same checks can cover the other eyelid and ophthalmology codes the practice bills.

Submit cleaner CPT 67924 claims

Pabau submits US claims through Claim.MD and tracks prior authorizations on each case. Practices can set up workflow checks for eyelid modifiers and diagnosis pairing before submission.

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Conclusion

Most 67924 denials trace back to the paperwork rather than the surgery. Payers cover functional entropion repair. Claims get denied when the operative report doesn’t name an extensive technique or the diagnosis lacks the eye and lid. A missing eyelid modifier does the same.

Before you assign 67924, read the op note for tarsal strip or retractor repair language. If it describes a tarsal wedge, sutures or cautery, the claim belongs on 67923, 67921 or 67922 instead. That single check protects the practice in a post-payment audit as well as at submission.

Practices can build these checks into their billing workflow in Pabau, so 67924 claims go out with the technique, diagnosis and modifier in place. For the wider revenue cycle, start with how medical billing works. Book a demo to see how Pabau handles claims and prior authorizations for surgical eye codes.

Continue your research

Billing a ptosis repair in the same session? CPT code 67904 covers external levator advancement and how it is documented alongside other lid repairs.

Adding a blepharoplasty to the claim? CPT code 15823 explains the upper lid blepharoplasty code and its functional documentation.

Want to understand how claim denials are managed? Denial management in healthcare covers the full workflow from initial denial through appeal and resubmission.

Looking for a complete overview of medical billing? What is medical billing breaks down the revenue cycle from patient registration through payment posting.

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