{
    "code": "67904",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/67904/2016/A",
    "release_specific_url": "https://localishealth.com/cpt/67904/2016/A",
    "description": "Surgery to raise a sagging upper eyelid by tightening the muscle that lifts it. Through an incision hidden in the eyelid crease on the outside of the lid, the surgeon exposes the levator muscle and its tendon, shortens or advances it, and reattaches it so the lid rests higher and opens fully. The external route is what marks this out from the related code that reaches the same muscle from underneath, through the inner lining of the lid.",
    "answer": {
        "question": "How much did Medicare pay for CPT 67904 in Q1 2016?",
        "text": "Medicare paid $740.43 for CPT 67904 in the office (non-facility) setting and $606.17 in a facility under the Q1 2016 Physician Fee Schedule, effective January 2016. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This is a 0.3% decrease from the previous quarter."
    },
    "release": {
        "schedule": "pfs",
        "year": 2016,
        "quarter": "A",
        "label": "Q1 2016",
        "effective": "January 1 – March 31, 2016",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 740.43,
        "facility": 606.17,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 7.97,
        "practice_expense_non_facility": 12.08,
        "practice_expense_facility": 8.33,
        "malpractice": 0.63
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 35.8043,
    "source": {
        "label": "Physician relative value file (Q1 2016)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu16a.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2016/A",
        "file": "PPRRVU16_V0122.csv",
        "row": 10973,
        "sha256": "e7973024293c4f8bd19119f0479a6b7bdc36435376c6b05a22fd3cd3cec5b13c"
    },
    "modified_at": "2026-08-04T03:06:29+00:00"
}