Blepharoplasty

Medicare covers blepharoplasty when performed for functional or reconstructive reasons—such as significant visual field impairment from dermatochalasis or ptosis, repair of eyelid defects from disease/trauma/tumor, symptomatic lower eyelid laxity (ectropion/entropion), congenital eyelid anomalies, prosthesis intolerance after failed modification, or refractory blepharospasm. Cosmetic procedures performed solely to improve appearance are not covered; coverage requires documented patient complaints, pertinent exam findings, and when applicable, superior visual field testing demonstrating a minimum 12-degree or 30% loss with demonstration of potential correction by lid elevation.

"Upper blepharoplasty is considered reconstructive and covered when excess upper eyelid tissue or abnormally low upper lid position produces functional visual complaints (e."

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