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Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift
A57191
Effective: January 1, 2025
Updated: December 6, 2025
Policy Summary
Covers billing and coding for blepharoplasty, eyelid surgery, and brow lift per the associated Local Coverage Determination; services are excluded if not supported as medically necessary. Key requirements: complete, legible medical records with patient identifiers and dates, CMS signature compliance, available pre‑op exam and operative report, and submitted ICD‑10 and CPT/HCPCS codes must accurately support the billed services.
Coverage Criteria Preview
Key requirements from the full policy
"H02."
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