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 anatomical abnormalities that impair vision or cause symptoms (e.g., trauma, ptosis with MRD1 ≤ 2 mm, significant superior visual field loss of 12–15° or 24–30% impairment, refractory pretarsal dermatitis, ectropion/entropion, or prosthesis difficulties in an anophthalmic socket). Procedures performed solely for cosmetic improvement are excluded. Documentation must include objective measurements (MRD1, visual field testing), evidence of failed conservative therapy where required, and compliance with CMS medical necessity and Medicare coverage/payment rules; services are subject to post-payment audit and medical review.

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