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Will Medicare Cover my Surgery for Droopy Eyelid? (photo)

I had glaucoma surgery 5 years ago. Since than my eyelid been droopy and it getting worst. I have a dr appt in Sept so I want to know if I should ask my eye dr about it. How much would it cost for repair in one eye if it isn't cover? I'm 30 from Houston and kidney transplant patient. I been dealing with it for years and makeup can't seem hide it no more. Thanks in advance for input

Doctor Answers 7

Will Medicare Cover my Surgery for Droopy Eyelid?

August 4th, 2013
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You do have significant right upper eyelid ptosis. Medicare may cover it, depending on how much it obstructs your vision, which is determined by a visual field test.  If insurance doesn't cover it, the cost varies $2000-4000. See an oculoplastic surgeon for evaluation.

Web reference: http://www.tabanmd.com/ptosis-droopy-upper-eyelid

Mehryar (Ray) Taban, MD, FACS


Beverly Hills Oculoplastic Surgeon
4.8 out of 5 stars 55 reviews

Will Medicare Cover my Surgery for Droopy Eyelid?

August 4th, 2013
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The short answer is yes. However, as with all insurances, this depends upon exactly what policy you have and what is considered a covered benefit. It is a great idea to have your ptosis evaluated to determine the exact cause of this problem. It can be repaired under local anesthesia or IV sedation. If someone recommends a simple blepharoplasty, move on to the surgeon that recommends a ptosis repair. They are not the same. An oculoplastic surgeon is typically the most experienced at dealing with this type of issue. Stephen Weber MD, FACS   

Web reference: http://weberfacialplasticsurgery.com/new-patients/

Stephen Weber, MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 123 reviews

Functional ptosis of the eyelid will be covered by Medicare.

August 14th, 2013
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From your description in the picture it seems likely that Medicare will cover correction of your ptotic right eye.

Web reference: http://www.zubowicz.com/subpag,22-atlanta-eyelid.htm

Vincent N. Zubowicz, MD

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 31 reviews

Obscured vision from a drooping lid

August 7th, 2013
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suggests it will be covered through Medicare.  You do need a visual field exam to document your peripheral vision loss and photos that show your lid encroaching on the pupil.  If you don't meet the criteria this year, you will in short time.  Find a local surgeon who can help you navigate the process of getting this covered as a medically necessary procedure.

Curtis Wong, MD

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Unilateral upper eyelid ptosis

August 4th, 2013
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The correction of unilateral upper eyelid ptosis can be a difficult problem.  Consultaton with an experienced occuloplastic or plastic surgeon is indicated.  Insurance coverage can be determined at the time of your consultation.  

Jeffrey Zwiren, MD

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

This will depend on the policies of the company that administers Medicare in your area.

August 4th, 2013
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I recommend asking your glaucoma specialist for a referral to an oculoplastic surgeon.  That way the oculoplastic surgeon will be fully informed regarding your glaucoma status and medical issues.  

Kenneth D. Steinsapir, MD

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Insurance coverage for eyelid surgery.

August 3rd, 2013
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Ptosis (eyelid droop) repair is typically covered by medical insurance.  Oculoplastic surgeons are in general the most qualified specialists to surgically correct ptosis.

Mario J. Imola, MD, DDS

Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 106 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.