What determines if an upper eyelid blepharoplasty is covered by insurance or Medicare?

The following three criteria are needed by Medicare and most insurance companies to consider an upper eyelid blepharoplasty a medical necessity, known as a functional versus [or rather than] a cosmetic procedure:

1. Documentation by the clinician of the diagnosis of dermatochlasia (excess skin) or ptosis (droopy upper eyelids).

2. Pre-operative photographs of the patient.

3. Documented improvement of more then 12 degrees in superior visual field with the eyelids taped compared to the eyelids untaped.


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