Blepharoplasty

General Documentation Requirements for Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair:

  • Documented excessive upper/lower lid skin;
  • Supporting pre-op photos;
  • Signed clinical notes support a decrease in peripheral vision and/or upper field vision;
  • Signed physician’s or non-physician practitioner recommendations
  • Documented subjective patient complaints which justify functional surgery (vision, ptosis, etc.);
  • Visual field studies/exams (when applicable).

Coverage Criteria

Codes

Code Description
15820 Removal of excessive skin of lower eyelid
15821 Removal of excessive skin of lower eyelid and fat around eye
15822 Removal of excessive skin of upper eyelid
15823 Removal of excessive skin and fat of upper eyelid
67900 Repair of brow ptosis
67901 Repair of upper eyelid muscle to correct drooping or paralysis
67902 Repair of upper eyelid muscle to correct drooping or paralysis
67903 Shortening or advancement of upper eyelid muscle to correct drooping or paralysis, internal approach
67904 Shortening or advancement of upper eyelid muscle to correct drooping or paralysis, external approach
67906 Suspension of upper eyelid muscle to correct drooping or paralysis
67908 Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis

 

The Prior Authorization for Certain Hospital Outpatient Department Part B Associated Codes List is in Appendix B of the CMS OPD Operational Guide.

Resources

 

Last Updated Fri, 07 Jan 2022 19:58:14 +0000