Blepharoplasty - Medical Policy Article

Medicare covers blepharoplasty and related eyelid surgeries when they are reconstructive and medically necessary to correct functional visual impairment, repair anatomical/pathologic eyelid defects, relieve exposure or tearing, treat chronic pretarsal dermatitis, or alleviate blepharospasm after failure of conservative therapy. Coverage requires documented patient complaints, clinical exam findings, photographic evidence, and objective visual field testing showing at least a 12-degree or 30% superior field loss with reproducible improvement when the lid is elevated; purely cosmetic procedures are excluded.

"Blepharoplasty is covered to correct visual impairment from dermatochalasis, including symptomatic redundant upper eyelid skin causing pseudoptosis or surgically induced dermatochalasis after ptosi..."

Sign up to see full coverage criteria, indications, and limitations.