Applies to
All plans
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 (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.