Blepharoplasty, Eyelid Surgery, and Brow Lift

Covered only when functional: upper blepharoplasty, blepharoptosis repair, and brow ptosis repair are allowed if redundant tissue or brow droop causes a visually significant superior field loss (≈30°) corresponding to MRD ≤2.0 mm (or pseudo‑MRD ≤2.0 mm for overhanging skin), with Herring’s effect documentation when used to justify bilateral repair. Exclusions and key requirements: lower eyelid blepharoplasty and cosmetic procedures are generally not covered; strict documentation (symptoms/ADL impact, MRD measurements, required frontal/lateral photographs with scale if needed, pre‑op exam and operative report, legible records, and separate documentation for each planned surgery) is required, and formal visual field testing is not required by policy.

"Blepharoptosis repair when: 'A margin reflex distance (MRD ."

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