Eyelid Surgery

Aetna covers upper eyelid blepharoplasty for anophthalmia prosthesis problems, functional visual impairment (requires photos within 12 months showing redundant tissue overhanging the lid margin and visual field testing with and without eyelid/brow taping showing pre-taping superior field ≤30° and a post‑taping increase of ≥12° or ≥30%), to relieve blepharospasm, and to treat peri‑orbital sequelae of thyroid disease or nerve palsy; lower lid blepharoplasty is covered for prosthesis difficulties but is rarely considered medically necessary for visual impairment. Intralesional bleomycin (HCPCS J9040) for periorbital microcystic lymphatic malformation with blepharoptosis (ICD‑10 I89.9, Q15.8) is experimental/investigational and not covered, and surgery for mild congenital ptosis done solely for cosmetic reasons is not covered.

"HCPCS code J9040 (bleomycin sulfate) is explicitly listed as not covered for indications in the CPB."