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The goal of functional or reconstructive surgery is to restore normalcy to a structure that has been altered by trauma, infection, inflammation, degeneration, neoplasia or developmental errors. The following are terms used to describe conditions which may require blepharoplasty:
-Title XVIII of the Social Security Act, section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary.
-Title XVIII of the Social Security Act, section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
-Title XVIII of the Social Security Act, section 1862(a)(7) excludes routine physical evaluations.
-Title XVIII Of the Social Security Act, section 1862(a)(10) excludes coverage for cosmetic procedures.
Contractor Name(Contractor Number) - Contractor Info
#9 - 12/29/2010
#9 - 12/29/2010
Open for comment 01/15/2011 - 03/01/2011, changes in Indications and Limitations and Documentation Requirement sections.
#8 - 04/06/2010
Revisions for consistency L1603 Trispan Legacy Policy, AC-03-048 Part B AR/LA, and ARA-03-048 AR Part A Policy effective 05/01/2010, CMS National Coverage Policy uniformity created, removal of CPT 15824 from the covered procedures for consistency of verbiage non covered; removal of ICD 701.8 (as other aging dermatologic diagnoses were defined and listed).
#7 - 08/10/2009 Admin
#6 - 04/08/2009
PBSI Part A policy retired in Rhode Island effective 05/31/2009 due to workload transition to J14 MAC contractor (NHIC).
#5 [ 11/26/2005 - The description for CPT/HCPCS code 67901 was changed in group 1 - The description for CPT/HCPCS code 67902 was changed in group 1]
#3, #4 - 12/20/2004
Policy revised to include Rhode Island (00021). This policy was presented to a special session RI CAC in October 2004, released on 12/30/2004 in the January 2005 newsletter, and effective with DOS 02/15/2005. Revised Sources to list specific LMRP titles in AR, LA and MO.
#1, #2 - 09/30/2004
Corrected typographical error by replacing LMRP with LCD. Revised Sources to list specific LMRP titles in AR, LA and MO.
8/10/2009 - The description for Revenue code 0760 was changed
8/10/2009 - The description for Revenue code 0761 was changed
8/10/2009 - The description for Revenue code 0762 was changed
8/10/2009 - The description for Revenue code 0769 was changed
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
08/19/2012 Transition to JH Mac
1. Local Medical Review polices from:
Arkansas - Blepharoplasty and/or Browptosis;
Louisiana - Blepharoplasty, RMP and Brow Surgical Procedures; and
Missouri (Eastern) - Plastic Surgery Procedures of the Eye (#34).
2. Kansas Local Medical Review policy titled "Blepharoplasty."
3. AR/LA Part B, AC-03-048
4. L1603 Trispan Legacy Policy
The Arkansas consortium combined policy was presented in December 2003 (AR) and October 2004 (RI) and accepted.
"This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from ophthalmology, plastic surgery, and dermatology."
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.11 - Hospital Inpatient (Including Medicare Part A)
13 - Hospital Outpatient
85 - Critical Access Hospital
Medicare Policies and Guidelines - NCD, LCD, Articles, LMRP
Summary: Medicare Policies and Guidelines - NCD, LCD, Articles, LMRP
Keywords: Medicare Policies and Guidelines, NCD, LCD, LMRP, national coverage determinations, local coverage determinations, local medical review policies
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