Blepharoplasty of upper lids

Applies to

All plans 

Medical policy

• Cosmetic and Reconstructive Surgery Procedures - 91535

Blepharoplasty coverage

Blepharoplasty of the upper eyelids is covered only when necessary due to functional impairment. See the criteria in the medical policy.

Non-standard cost-sharing

If/when commercial employer group and MyPriority^® individual plans cover certain surgeries, these surgeries may be covered at a different cost-sharing level than our standard benefit coverage levels.

To verify member cost sharing and coverage, use the Member Inquiry tool and look in the Additional benefits drop-down menu for Certain surgeries benefit information.

Blepharoplasty authorizations

Participating providers: Use our online authorizations tool (login required) to go to GuidingCare.

Non-participating providers: Use this Medical Authorization form.

Blepharoplasty billing

See the medical policy for codes that may apply and codes not covered.