Paralytic Lagophthalmos Treatments

Aetna covers gold- or platinum-weight eyelid implants or palpebral springs for paralytic lagophthalmos and, for chronic severe cases with no reasonable likelihood of nerve recovery on electromyography/electroneuronography (EMG/ENoG), muscle transposition (including silicone‑sling temporalis transfer), neuroplastic procedures (e.g., cross‑facial nerve grafting), and autologous lower‑eyelid spacing grafts; botulinum toxin, hyaluronic acid, lipofilling, implants for other indications, and listed CPT/HCPCS (e.g., J0585, 15773, 64612) are considered experimental/investigational. Coverage of implants/springs requires ALL selection criteria — expected delayed/incomplete facial nerve recovery, exposed cornea with inadequate lacrimation, and failure of conservative therapy — and the listed surgical procedures require documentation that spontaneous return of function is unlikely per EMG/ENoG.

"Covered ICD-10 diagnoses (covered if selection criteria are met): H02."