Medicare prior authorization · 67900
67900 — Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair
Subject to the hospital outpatient department prior authorization program nationwide when furnished in a hospital outpatient department. Subject to CMS’s ASC prior authorization demonstration when furnished in an ambulatory surgical center in CA, FL, TN, PA, MD, GA, NY, TX, AZ, OH. The decision is made on Medicare’s existing coverage policy; nothing in these programs changes what is covered.
The coverage policy the reviewer applies, by contractor
CMS publishes no policy references for this program’s code list. The policies below are the ones whose own procedure-code tables list 67900 — matched by CLV analysis; the linked CMS document is authoritative. Each state’s contractor writes its own, so the policy that decides a request depends on the state.
Noridian · 16 states: AK, AS, AZ, CA, GU, HI, ID, MP, MT, ND, NV, OR, SD, UT, WA, WY
- L34194 — Blepharoplasty, Eyelid Surgery, and Brow Lift — Noridian · CMS version 27 · captured 2026-07-24
- L36286 — Blepharoplasty, Eyelid Surgery, and Brow Lift — Noridian · CMS version 22 · captured 2026-07-24
This contractor publishes more than one policy listing 67900, and the capture records the contractor rather than the jurisdiction — so which one governs depends on the jurisdiction serving the state. Run the check for your state.
Novitas · 12 states: AR, CO, DC, DE, LA, MD, MS, NJ, NM, OK, PA, TX
- L35004 — Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow — Novitas · CMS version 23 · captured 2026-09-12
Read the documentation requirements in the linked CMS document.
Palmetto GBA · 7 states: AL, GA, NC, SC, TN, VA, WV
- L34411 — Blepharoplasty, Eyelid Surgery, and Brow Lift — Palmetto GBA · CMS version 46 · captured 2026-09-12
Read the documentation requirements in the linked CMS document.
WPS · 6 states: IA, IN, KS, MI, MO, NE
- L34528 — Blepharoplasty, Blepharoptosis and Brow Lift — WPS · CMS version 38 · captured 2026-07-25
Read the documentation requirements in the linked CMS document.
First Coast · 3 states: FL, PR, VI
- L34028 — Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow — First Coast · CMS version 16 · captured 2026-09-12
Read the documentation requirements in the linked CMS document.
CGS Administrators · 2 states: KY, OH
- L33944 — Blepharoplasty — CGS · CMS version 27 · captured 2026-07-25
Read the documentation requirements in the linked CMS document.
Hospital-OPD prior authorization program
- Where
- nationwide, hospital outpatient department only
- Decision
- 7 calendar days; 2 business days expedited
- Coverage policy
- the MAC’s LCD for the state — the check below finds it
- CMS note
- Since 2020-07-01. 67911 removed 2022-01-07.
ASC prior authorization demonstration
- Where and from when
- ambulatory surgical center only; CA, FL, TN, PA, MD, GA, NY for dates of service on or after 2026-01-19; TX, AZ, OH for dates of service on or after 2026-02-16
- Decision
- 7 calendar days; 2 business days expedited; valid 120 days
- If no request is made
- prior authorization is voluntary; the claim is stopped for prepayment medical record review
- Submit
- the ASC submits to its MAC by mail, fax, esMD (content type 8.7) or the MAC’s portal
- Exemption
- not yet published: “CMS will provide further information regarding exemption.”
Check 67900 for your state, diagnosis and setting
The governing policy as it stands today, whether the diagnosis is on its list, and the documentation the policy’s own text requires — quoted, source-linked, free.
Run the check →Full lists: hospital outpatient code list · ASC demonstration code list
Same family: 15820 · 15821 · 15822 · 15823 · 67901 · 67902 · 67903 · 67904 · 67906 · 67908
Sources: CMS WISeR Provider and Supplier Operational Guide v7.0 (2026-07-24), Appendix A; CMS list of OPD services requiring prior authorization (2024-08-05); CMS list of ambulatory surgical center services for prior authorization (2026-03-05) and the ASC Operational Guide (2026-03-03). Codes are shown as numbers only, as CMS lists them. CPT® is a registered trademark of the American Medical Association.