Billing and Coding: Blepharoplasty

Blepharoplasty coverage requires documentation of medical necessity in the medical record, including history, exam, and pertinent test results; for Group 2 codes visual field testing and/or photographs are required. Specific documentation is required when dermatochalasis is induced by ptosis repair (demonstrate levator aponeurosis dehiscence and operative note showing residual skin excess), claims must include valid ICD-10 codes and required provider identifiers, and ABN rules/modifiers (-GA, -GX, -GZ, -GY) apply for anticipated non-coverage.

"Blepharoplasty is covered when medical necessity is documented in the medical record, including relevant history, physical exam, and diagnostic test results that support the procedure per the appli..."

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