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Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift
A57190
Effective: October 16, 2025
Updated: December 31, 2025
Policy Summary
Coverage for blepharoplasty, eyelid surgery, and brow lift is allowed when the medical record documents medical necessity consistent with the associated Local Coverage Determination. Claims must be supported by complete, legible medical records with patient identification, CMS-compliant signatures, a pre-operative exam and operative report, and correct ICD-10-CM and CPT/HCPCS coding; lack of these documentation elements or coding support may result in denial.
Coverage Criteria Preview
Key requirements from the full policy
"Blepharoplasty, eyelid surgery, or brow lift is covered when the medical record documents medical necessity consistent with the associated Local Coverage Determination (LCD)."
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