Blepharoplasty, eyelid surgery, brow lift, and related services
Blepharoplasty, blepharoptosis repair and brow lift are surgeries that may be performed to improve function or provided strictly for cosmetic reasons. Functional or reconstructive eyelid surgery is performed to improve abnormal function, reconstruct deformities, repair defects due to trauma or to restore normalcy to the eyelids. Medicare considers surgeries performed to improve function as reasonable and necessary. Surgeries performed solely for cosmetic reasons are not considered reasonable and necessary and are, therefore, not covered by Medicare.
General documentation requirements
- Documented subjective patient complaints which justify functional surgery (vision obstruction, unable to do daily tasks, etc.)
- Documented excessive upper / lower lid skin
- Signed clinical notes support a decrease in peripheral vision and/or upper field vision causing the functional deficit (when applicable)
- Signed physician’s or non-physician practitioner’s documentation of functional impairment and recommendations
- Supporting pre-op photos (when applicable)
- Visual field studies/exams (when applicable)
Codes
The services for the following CPT codes are subject to prior authorization (PA) for blepharoplasty, eyelid surgery, brow lift, and related services if performed in a hospital outpatient department (HOPD) for dates of service on or after July 1, 2020.
| Code | Description |
|---|---|
| 15820 | Blepharoplasty, lower eyelid |
| 15821 | Blepharoplasty, lower eyelid; with extensive herniated fat pad |
| 15822 | Blepharoplasty, upper eyelid |
| 15823 | Blepharoplasty, upper eyelid; with excessive skin weighting down lid |
| 67900 | Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) |
| 67901 | Repair of blepharoptosis; frontalis muscle technique with suture or other material (e.g., banked fascia) |
| 67902 | Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) |
| 67903 | Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach |
| 67904 | Repair of blepharoptosis; (tarso) levator resection or advancement, external approach |
| 67906 | Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) |
| 67908 | Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (e.g., Fasanella-Servat type) |
Note: CPT 67911 (Correction of lid retraction) was removed on January 7, 2022, for prior authorization for hospital outpatient departments (HOPDs).
References
- LCD: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (L34028)
- LCA: Billing and Coding: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (A57025)
- CMS Pub. 100-02 Medicare Claims Processing Manual Chapter 16, section 10 and 120
- Title XVIII of the Social Security Act, Section 1862 (a)(10) - This section excludes Cosmetic Surgery.
- CMS Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
- CMS Final List of Outpatient Services That Require Prior Authorization