Medicare Blog

what criteria is needed for medicare to pay for eyelid surgery

by Eveline Beier Published 2 years ago Updated 1 year ago

Typically, for eyelid surgery to be considered medically necessary, it must be for reconstructive purposes, such as: You have drooping eyelids (ptosis) that causes visual impairment. A trauma or another eye surgery caused defects to your eyelid.

How do you qualify for eyelid surgery?

One can qualify for eyelid surgery, covered by medical insurance, if it is deemed medically necessary. The main reason cited is impaired vision is caused by excess upper eyelid skin which can make everyday activities such as driving, reading and using telecommunication devices much more hazardous.

When is a blepharoplasty medically necessary?

Typically, an upper-eyelid blepharoplasty can be considered medically necessary when the upper-eyelid skin is drooping down to the extent that it is blocking vision, usually within the superior visual fields.

Who is not a good candidate for eyelid surgery?

People who are not ideal candidates for eyelid surgery are those who suffer from chronic dry-eye, hypertension, circulation disorders, thyroid disorders, diabetes or heart disease. Individuals who have glaucoma are advised to speak with their doctor before considering the surgery to find out if it is safe for them.

How can I get my insurance to cover a droopy eyelid?

In general, insurance companies will cover blepharoplasty or ptosis repair if the eyelids cause a “visually significant” obstruction of the upper visual field that “affects activities of daily living”.

Can eyelid surgery be covered by Medicare?

Eyelid surgery (blepharoplasty) may be covered by Medicare if it is considered medically necessary and reconstructive (rather than cosmetic).

How much does eyelid surgery cost?

The average cost of cosmetic eyelid surgery is $4,120, according to 2020 statistics from the American Society of Plastic Surgeons.

What is the best age for eyelid surgery?

You can have a blepharoplasty at any time. But if you're seeking one due to aging, you'll usually get the best results after age 40. People who are advanced in age should generally avoid the procedure because of the risks of surgical complications.

What is the age limit for blepharoplasty?

Since the eyelid surgery or Blepharoplasty is a minor procedure, there is no age limit attached to it. Usually, people over 30 years of age undergo this eyelid surgery due to the signs of aging.

Who is a candidate for eyelid surgery?

In general, a good candidate is someone who: Has sagging skin causing folds or drooping in the upper or lower eyelid. Has puffiness in the upper eyelid due to excess fat deposits. Has bags under the eyes, or droopiness of the lower eyelids.

How long is recovery from eyelid surgery?

Your eyelid may be swollen and bruised for 1 to 3 weeks after surgery. The appearance of your eye may continue to get better for 1 to 3 months. Most people feel ready to go out in public and back to work in about 10 to 14 days. This may depend on your job and how you feel about people knowing about your surgery.

Is eyelid surgery painful?

Eyelid surgery is among the least painful cosmetic procedures. Aside from minimal discomfort on the day, you'll have a quick recovery and see the results swiftly. So the procedure isn't very painful, but you may have other questions.

Do hooded eyes affect eyesight?

Droopy eyelids can limit your field of vision. This may happen as the result of ptosis, or the lowering of the upper eyelid. It may also be related to dermatochalasis, or excess skin around the eyes. Droopy eyelids can obstruct your vision and reduce your quality of life.

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