Blepharoplasty of upper lids

Applies to:

All plans


Blepharoplasty is the surgical removal of excess fat, muscle and/or skin from the eyelids or from under the eyes.

Medical policy

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 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.