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Dr. Matheson Harris: Let's talk about the requirements by Medicare, which are very similar to most of the other insurance carriers. For your own specific insurance, it's important that you read your policy, to determine your exact requirements.

Eyelid lifting or blepharoplasty, is considered "medically necessary," when it's used as a "functional or reconstructive surgery." This means that it has to improve your vision in some way or decrease eye irritation. They list the following acceptable indications on the Medicare website: first, 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. Second, if there symptomatic redundant skin, weighing down on the upper eyelashes.

Surgery can also be covered if you have chronically irritated eyelids, due to excess skin or your glasses can't be worn properly, due to excess skin. We perform tests in the office, to prove that these problems exist. Medicare requires that we document your complaints about the problems we just mentioned. 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 2.5 millimeters 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 between 20 and 30 degrees upward, and improved by at least 12 degrees when the eyelids are raised.

Eyelid Surgery Insurance Requirements

Dr. Matheson Harris discusses insurance requirements for Eyelid Surgery.

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