If vision is impaired by excess eyelid skin, then yes, procedure 15823

Jonathan Hoenig, MD answers: What are the requirements to have insurance cover blepharoplasty?

Excess upper eyelid skin runs in both sides of my family, and most have impaired vision by their late 50s. At 37, my upper eyelids hang over my lashes; the excess skin is about 1/2" when pinched with no apparent fat, just skin sagging over lashes. I'm used to it, but there is definitely an upper black line in my vision where the lids are pressing down, and I can "see" my lashes at all times.

What are the usual requirements to gain insurance approval with a good PPO? Is this even possible, or is it always considered cosmetic?


Jonathan Hoenig, MD
7 months ago

If the excess eyelid skin is pushing down your eyelids and your vision is impaired, then insurance may help cover the costs.

The definitive test required by the insurance companies is the visual field exam - taped and untaped. You'll look at some flashing lights and push a button when you see the light. Then you'll repeat the test after having your eyelids taped up. The computer records how many you saw and how many you missed. It also keeps track of false positives and negatives, so it doesn't help to cheat.

If the test shows that your vision in the upper fields have improved by have your eyelid skin removed from your field of view, then insurance will likely cover it. Unless it's medicare, they may also require preop photos and a letter of medical necessity submitted to them for prior authorization before surgery.

Of course, all of this depends on your insurance coverage. Contact your insurance company to make sure that its not excluded from your policy. The procedure code is 15823. If it is covered, you'll still be responsible for meeting your deductible and co-pays, based on your coverage.

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