Billing and Coding: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow

Blepharoplasty, blepharoptosis repair, and surgical brow procedures are covered when medical necessity is documented by objective criteria such as superior visual field loss (12–15 degrees or 24%–30% impairment), MRD1 ≤2 mm, palpebral fissure on down-gaze ≤1 mm, or functional problems (dermatitis, ectropion, entropion, prosthesis intolerance). Required documentation includes legible medical records, supporting ICD-10/CPT coding, pertinent diagnostic tests (including visual field testing), and preoperative photographs when records are insufficient; each planned procedure must be independently documented. Removal of skin lesions and Mohs surgery must be reported with the appropriate lesion/Mohs CPT codes, and non-covered services must be billed with the appropriate modifier and proper code combinations per NCCI guidance.

"Medically necessary upper eyelid blepharoptosis repair may be paid when performed concurrently with cosmetic blepharoplasty on the same eye during the same visit if medical necessity is documented."