Billing and Coding: Blepharoplasty, Blepharoptosis and Brow Lift

Coverage for blepharoplasty, blepharoptosis repair, and brow lift is limited to cases with documented signs or symptoms of functional abnormality of the upper eyelids as defined in the associated LCD (L34528); procedures performed solely for cosmetic reasons are not covered. Claims must include precise, highest-level diagnosis coding supporting medical necessity; cosmetic services submitted at the patient's request must be billed with modifier GY and ICD-10 Z41.1 in the first position. Visual field tests are billed as bilateral on a single claim line (no 50/RT/LT), with modifier 52 used only if performed on one eye for the date of service; photographs are not separately billable.

"Blepharoplasty, blepharoptosis repair, or brow lift is covered when documented signs or symptoms of a functional abnormality of the upper eyelids are present as defined by the associated LCD (L34528)."