Many patients come to our office for eyelid surgery and their question generally is “what are the eyelid surgery insurance requirements”, or “will my insurance cover this procedure.” Let’s talk about the eyelid surgery requirements by Medicare, which are very similar to most other insurance carriers. For your own specific insurance is important that you read your policy determine your exact eyelid surgery insurance requirements.
Eyelid lifting or blepharoplasty is considered medically necessary when it is used as a functional or reconstructive surgery. This means it has to improve your vision in some way, or decrease eye irritation. They list the following acceptable indications for eyelid surgery:
1. Impairment of near or far vision caused by excessive eyelid skin, chronically swollen eyelid skin, or drooping eyelids, which are usually due to a stretched out muscle tendon in older adults.
2. Symptomatic redundant skin weighing down on the upper eyelashes.
Upper eyelid blepharoplasty
3. Chronically irritated eyelids due to excess skin or difficulty wearing glasses due to excess skin.
Eyelid surgery testing
We perform tests in the office to prove that these problems exist. Medicare requires the we document your complaints about the problems above. They also require photos be taken that clearly show the problems. We also take measurements of the position of the eyelids and must show that the upper eyelid is drooping within 2.5mm of the center of the pupil, or that the eyelid skin is resting on the eyelashes. Lastly, we perform a visual field test, which shows that the peripheral vision is limited and improves once we raise up the eyelids. Peripheral vision must be limited to between 20 and 30 degrees upward and improve by at least 12 degrees when the eyelids are raised.
If you are bothered by heavy or droopy eyelids, please call our office for an eyelid surgery consultation at 801-264-4420 or go to utahoc.com for more information.