Soft tissue repair · Other

21282

Surgical tightening and reattachment of the lateral canthal tendon to restore the outer corner of the eyelid to its correct anatomical position.

Verified May 8, 2026 · 6 sources ↓

Medicare
$369.41
Total RVUs
11.06
Global, days
90
Region
Other
Drawn from CMSAAPCEmednyNIHEyes

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

  • Clinical indication: specify eyelid laxity, malposition, retraction, or functional impairment (e.g., exposure keratopathy, epiphora) driving the procedure
  • Operative note must identify the lateral canthal tendon by name and describe its condition — lax, attenuated, displaced, etc.
  • Document the specific fixation technique: suture type, anchoring site (periosteum, orbital rim, or other structure), and degree of tension applied
  • State whether the canthopexy was performed as a standalone procedure or combined with concurrent periorbital procedures (blepharoplasty, levator repair, etc.)
  • For bilateral cases, document each side separately with independent findings supporting bilateral intervention
  • Photographs or slit-lamp findings supporting functional impairment are required by most payers when billing for medical necessity rather than cosmetic indication

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21282 describes a lateral canthopexy — a procedure in which the lateral canthal tendon is tightened and anchored to correct lower eyelid laxity, malposition, or retraction at the outer canthus. The surgeon makes a small incision at the lateral canthal angle, adjusts the tension on the tendon, and secures it to the orbital rim periosteum or adjacent tissue to restore eyelid position and function. The procedure is performed for functional indications (exposure keratopathy, poor eyelid closure, tearing) as well as in conjunction with blepharoplasty or other periorbital reconstruction.

This code carries a 90-day global period. Routine follow-up visits, wound checks, and suture removal through day 90 are bundled. Unrelated E/M services in that window require modifier 24; a separate significant E/M on the day of surgery needs modifier 25. When lateral canthopexy is performed bilaterally in the same session, append modifier 50. When combined with a distinct concurrent procedure such as levator advancement (67904) or blepharoplasty (15822/15823), modifier 51 or 59 may be needed depending on NCCI edits — verify pair-specific edit status before billing.

The code appears in the musculoskeletal head section of CPT, not the ophthalmology section, which trips up coders who expect it near 67900-series eyelid codes. The procedure is distinct from canthoplasty (67950), which involves more extensive reconstruction of the canthal angle itself, and from lateral tarsal strip (67917), which addresses the tarsal plate rather than the tendon alone. Selecting the wrong code based on operative note language is a common audit finding.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU4.16
Practice expense RVU6.39
Malpractice RVU0.51
Total RVU11.06
Medicare national rate$369.41
Global period90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$369.41
HOPD (APC 5164)
Hospital outpatient department
$3,387.27
ASC (PI A2)
Ambulatory surgical center (freestanding)
$1,480.50

Common denial reasons

The recurring reasons claims for CPT 21282 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

  • Cosmetic exclusion: payer denies when documentation doesn't establish a functional indication — document visual field compromise, corneal exposure, or tearing explicitly
  • Wrong code family: billing 21282 when operative note describes tarsal strip (67917) or canthoplasty (67950) — code selection must match the documented technique
  • Bundling denial when billed same-day with overlapping periorbital codes without appropriate modifier 51 or 59 to establish distinct procedural service
  • Global period conflict: E/M or follow-up visits billed within the 90-day global without modifier 24 to indicate an unrelated service
  • Missing laterality: bilateral cases not appended with modifier 50, or LT/RT missing when payer requires unilateral billing on separate lines

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01How does 21282 differ from 67917 (lateral tarsal strip)?
21282 targets the lateral canthal tendon — tightening and reanchoring it to the orbital rim. CPT 67917 addresses the tarsal plate itself, creating a stripped tarsal surface for fixation. The procedures differ anatomically and surgically. Bill based on what the operative note describes, not the outcome. Applying the wrong code based on diagnosis alone is the most common error.
02Can 21282 be billed with blepharoplasty codes on the same day?
Yes, when performed through a separate incision or with clearly documented distinct work. Check NCCI PTP edits for the specific pairing (e.g., 21282 with 15822 or 15823). If an edit exists without a modifier indicator of 1, the procedures cannot be unbundled regardless of documentation. When allowed, modifier 59 or XS applies if the services are at a distinct anatomic site or separate encounter.
03Is lateral canthopexy covered for cosmetic blepharoplasty patients?
Not automatically. If the canthopexy is performed solely to improve cosmetic appearance without a documented functional deficit, most payers — including Medicare — will deny it. You need documented functional impairment: corneal exposure, epiphora, or visual field restriction. Cosmetic blepharoplasty context increases scrutiny significantly.
04What modifier applies when bilateral lateral canthopexy is performed in the same session?
Append modifier 50 to 21282 and bill a single line. Reimbursement is typically limited to 150% of the single-procedure allowable. Some payers require separate LT and RT lines instead — confirm payer preference before submitting.
05Does the 90-day global period on 21282 bundle concurrent eyelid procedures?
The global bundles the surgery itself, the day-before pre-op visit, and routine post-op care through day 90. It does not bundle separately billable concurrent procedures performed at the same session — those require appropriate modifiers. Unrelated E/M visits during the global need modifier 24. A planned staged procedure by the same surgeon within the global needs modifier 58.
06Why is 21282 listed under musculoskeletal head codes rather than ophthalmology?
CPT places canthopexy procedures (21280 medial, 21282 lateral) in the musculoskeletal section under repair and reconstruction of the head — not the eyelid repair section (67900 series). This is a known source of lookup errors. Coders searching the ophthalmology section won't find it there. Both oculoplastic surgeons and plastic surgeons use this code regularly.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    aapc.com
    https://www.aapc.com/codes/cpt-codes/21282
  3. 03
    emedny.org
    https://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
  4. 04
    cms.gov
    https://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
  5. 05
    pmc.ncbi.nlm.nih.gov
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9675511/
  6. 06
    eyes.arizona.edu
    https://eyes.arizona.edu/sites/default/files/cpt_codes.pdf

Mira AI Scribe

Mira's AI scribe captures the specific indication (eyelid laxity, malposition, or functional deficit), the laterality, the tendon condition as dictated, and the fixation technique including anchoring site and suture details. It flags when the operative note uses language consistent with tarsal strip or canthoplasty rather than canthopexy — a distinction that determines correct code selection and prevents post-audit downcodes.

See how Mira captures CPT 21282 documentation

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