Does Medicare pay for Eyelid Surgery?

One eyelid is drooping

Doctor Answers 12

Droopy eyelids

There are two different types of upper eyelid visual problems due to obstruction:
 1. A large hood of excess droopy SKIN that actually blocks part of your peripheral vision; and
 2. The other is true ptosis (low hanging eyelid) of the lid which is due instead to a weak or detached muscle

Regardless, both must be documented by a visual field test from your ophthalmologist. Even in the best case, Medicare may NOT covered the surgery. The problem is that Medicare won't tell us until after the surgery is over. At that point, they may write us a letter and say, "you know what, that wasn't truly necessary and we won't pay you." For this reason, most eyelid surgeons now have you pay them first, and place the burden on trying to collect from Medicare on you, after the surgery. Hope this makes sense, because it certainly doesn't to any of us.....

Jacksonville Plastic Surgeon
4.9 out of 5 stars 32 reviews

Medicare reimbursement

Medicare does not provide preauthorization or a letter of agreement to pay even with evidence of upper lid ptosis.  Therefore the surgeon may do the procedure and then not be reimbursed.  It is a difficult situation for surgeons to be in thus many prefer not to take the risk.  Not to mention the low reimbursement if it is covered. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

When the upper eyelids can be documented to interfere sufficiently with vision, the answer is yes.

Unfortuately, Medicare is at war with surgeons who offer this service to patients who need medically necessary eyelid surgery.  More and more surgeons are fed up with the low reimbursement and the hassle involved with providing this service.  Increasingly they are simply advising their patients that their issues are not covered.  

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Does Medicare pay for Eyelid Surgery?

Yes but only upper lids if you have visual field defect. Only after a eye doc does visual field exam than you can consider trying for Medicare reimbursement. But most of the PSs will not accept because it is so low, in the few hundred $ range.. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Medicare and eyelid surgery

It will ppay for the upper lids in some case but not the lower lids.You have to have visual fields studies done before your surgery and they have to show significant visual field loss before they will pay.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 62 reviews

Does Medicare pay for Eyelid Surgery?

Its purely a gamble that most surgeons are not willing to take. All sorts of documnetaion is needed including peripheral visual fileds. Good luck

Jose Perez-Gurri, MD, FACS
Miami Plastic Surgeon
4.9 out of 5 stars 232 reviews

Does Medicare Pay for Upper 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.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

Eyelid surgery and insurance

If you have a large hood of excess droopy skin that actually blocks part of your visiin and this is documented by a visual field rest by your ophthalmologist it can likely be covered by insurance.If you have true ptosis of the lid which is due instead to a weak or detached muscle this also often is covered but a different type of procedure that your surgeon can explain

Robert Savage, MD (retired)
Wellesley Plastic Surgeon
5.0 out of 5 stars 3 reviews

Does Medicare pay for eyelid surgery?

In order for an insurance company to pay for upper eyelid surgery, medical necessity must be documented. This involves pictures, visual field obstruction tests, and chart notes. A large and significant portion of the visual fields muust be obstructed from excess skin cutting across the eyelashes and creating visual loss. Preauthorization is also performed for medical insurance prior to the surgery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Medicare reimbursement for eyelid surgery

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.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 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.