Summary & Overview
CPT 67820: Correction of Trichiasis by Forceps Epilation
CPT code 67820 represents the correction of trichiasis by epilation using forceps, a procedure performed by ophthalmologists to remove misdirected eyelashes that pose a risk to ocular health. This code is nationally recognized and is relevant for providers and payers managing ophthalmic conditions that require precise, minimally invasive intervention. The procedure is typically conducted in an ophthalmologist's office and is distinct from other trichiasis correction methods that may involve different instruments or techniques.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of clinical indications, billing benchmarks, and policy updates related to CPT 67820. Readers will gain insight into payer coverage, typical sites of service, and the clinical context for this procedure. Additionally, the report highlights relevant modifiers, associated taxonomies, ICD-10 diagnoses, and related CPT codes, offering a complete picture for stakeholders involved in ophthalmology billing and policy. This summary is designed to inform healthcare professionals, billing specialists, and policy analysts about the national landscape for trichiasis correction by forceps epilation.
CPT Code Overview
CPT 67820 is used to report the correction of trichiasis through epilation, performed exclusively with forceps. This procedure is a targeted intervention within ophthalmology to address abnormal eyelash growth that can cause irritation or damage to the eye. The typical site of service for this procedure is an ophthalmologist's office, most commonly designated as Place of Service 11. The code is specific to cases where forceps are the sole method used for epilation, distinguishing it from other approaches to trichiasis correction.
Clinical & Coding Specifications
Clinical Context
A patient presents to an ophthalmologist's office with complaints of irritation and discomfort in the eye, often described as a sensation of something rubbing against the eye surface. Upon examination, the ophthalmologist identifies trichiasis, which is the misdirection of eyelashes toward the cornea, without associated entropion. The affected eyelid may be the right upper, right lower, left upper, left lower, or unspecified. The ophthalmologist performs epilation using forceps to remove the offending eyelashes, providing relief from symptoms. This procedure is typically performed in the office setting and may be done on one or both eyes, depending on the extent of the condition.
Coding Specifications
- Modifier
50: Indicates a bilateral procedure when epilation is performed on both eyes during the same session.
| Modifier Code | Description |
|---|---|
50 | Bilateral procedure on both eyes |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
174400000X | Ophthalmology |
- Ophthalmology specialists are the primary providers for this procedure.
Related Diagnoses
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H02.051- Trichiasis without entropion, right upper eyelid- Indicates trichiasis affecting the right upper eyelid, relevant for targeting the specific area during epilation.
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H02.052- Trichiasis without entropion, right lower eyelid- Refers to trichiasis in the right lower eyelid, guiding the procedure location.
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H02.053- Trichiasis without entropion, left upper eyelid- Specifies trichiasis in the left upper eyelid, important for documentation and coding.
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H02.054- Trichiasis without entropion, left lower eyelid- Applies to trichiasis in the left lower eyelid, relevant for procedure coding.
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H02.059- Trichiasis without entropion, unspecified eyelid- Used when the affected eyelid is not specified, but trichiasis is present and treated with epilation.
Related CPT Codes
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67825- Correction of trichiasis; epilation by other than forceps- Used when the epilation is performed by methods other than forceps, such as electrolysis or laser. This is an alternative to
67820when a different technique is used.
- Used when the epilation is performed by methods other than forceps, such as electrolysis or laser. This is an alternative to
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67938- Removal of embedded foreign body, eyelid- May be performed if a foreign body is present in the eyelid, which can occur alongside trichiasis but is a distinct procedure.
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67961- Excision and repair of eyelid- Used for more extensive eyelid repair, which may be necessary if trichiasis is associated with structural eyelid abnormalities.
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92002- Ophthalmological services; medical examination and evaluation, new patient- Commonly used in conjunction with
67820for the initial evaluation of a new patient presenting with trichiasis.
- Commonly used in conjunction with
National Reimbursement Benchmarks
Nationally, Medicare's mean rate for CPT code 67820 is $19.23, which is significantly lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, and Aetna) commercial average of $43.97. Among individual commercial payers, UnitedHealth Group and Cigna have the highest mean rates at $53.02 and $52.47, respectively, while Aetna is the lowest at $37.53.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare shows the tightest range at $2.00, indicating minimal variation in rates. In contrast, Cigna and UnitedHealth Group exhibit the widest dispersions, with ranges of $36.00 and $30.17, respectively, reflecting greater variability in commercial reimbursement. The table and chart below present the full breakdown of national benchmarks for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.