Does Medicare pay for Eyelid Surgery?

The answer is yes if there is significant visual field impairment which is documented by visual field testing. However, there is an assumption by many Medicare age patients that Medicare will pay for upper eyelid Blepharoplasty for any patient who wishes to have it.  This assumption is incorrect, and has lead CMS to carefully scrutinize utilization of this procedure. In addition, the reimbursement by CMS is very low for a procedure that has tremendous aesthetic consequences.  Fewer and fewer Facial Plastic Surgeons are accepting functional eyelid patients because the risk to reward ratio is inappropriate for the procedure.

If you have a ptosis or excess upper eyelid skin that is falling over your lashes your insurance may cover for the surgical repair.  You have to do a visual field to document that you have superior field loss from the low eyelids. Photos will also be taken.  Many insurance companies will require pre-authorization which they will base on the fields and photos. With medicare, you doctor will decide if you meet the criteria for coverage.  Medicare and all the insurances continue to decrease the reimbursement for surgery, so many doctors will no longer accept the insurance for payment.