Blepharoplasty, Blepharoptosis and Brow Lift

Blepharoplasty, blepharoptosis repair, and brow lift are covered when eyelid or brow malposition causes documented functional visual impairment (including specified MRD and down-gaze palpebral fissure thresholds) or when redundant skin causes chronic dermatitis or prosthesis difficulty in an anophthalmic socket. Coverage requires documentation of symptoms, objective measurements (MRD ≤2.5 mm; down-gaze palpebral fissure ≤1 mm), and, except for anophthalmic-socket cases, visual field testing showing ≥12° or ≥30% superior improvement with manual elevation; surgery for blepharospasm is covered only after other treatments (eg, Botulinum toxin) have failed or are contraindicated.

"Upper blepharoplasty or ptosis repair is medically necessary when upper eyelid or brow descent produces functional visual complaints (visual field impairment in primary gaze or down-gaze/reading)."