Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow

Blepharoplasty, blepharoptosis repair, and surgical brow procedures are covered when performed to restore function or correct structural abnormalities (eg, trauma, neoplasm, ptosis, brow ptosis with MRD1 ≤ 2 mm) or when there is demonstrable visual field impairment, symptomatic dermatitis unresponsive to conservative care, prosthesis issues in an anophthalmic socket, ectropion, or entropion. Procedures performed solely for cosmetic improvement are not covered. Documentation must include objective measurements (MRD1, visual field testing) and evidence of failed conservative therapy when applicable, and records are subject to post‑payment review and CMS medical necessity requirements.

"Surgery to restore function or normalcy to eyelid or brow structures altered by trauma, infection, inflammation, degeneration, neoplasia, or developmental anomaly is covered."

Sign up to see full coverage criteria, indications, and limitations.