Upper Eyelid Blepharoplasty and Blepharoptosis Repair (update eff 10/01/2017)

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
October 3rd, 2016

Effective October 1, 2017, CMS revised this policy to allow either cosmetic or medically necessary blepharoplasty to be performed in conjunction with a medically necessary upper eyelid blepharoptosis surgery. Specifically, physicians may receive payment for a medically necessary upper eyelid blepharoptosis from Medicare even when performed with (non-covered) cosmetic blepharoplasty on the same eye during the same visit. Since cosmetic procedures are not covered by Medicare, advanced beneficiary notice of noncoverage instructions would apply for cosmetic blepharoplasty. However, medically necessary blepharoplasty will continue to be bundled into the payment for blepharoptosis when performed with and as a part of a blepharoptosis surgery.

CMS previously stated in 2016 the following:  

The Centers for Medicare & Medicaid Services (CMS) payment policy does not allow separate payment for a blepharoplasty procedure (CPT codes 1582215823) in addition to a blepharoptosis procedure (CPT codes 67901-67908) ontheipsilateral upper eyelid. Any removal of upper eyelid skin in the context of an upper eyelid blepharoptosis surgery is considered apart of the blepharoptosis surgery.

Other aspects of the July 2016 ASC Update CR and MLN guidance on upper eyelid blepharoplasty and blepharoptosis remain unchanged. 

A blepharoplasty cannot be billed to Medicare and the beneficiary cannot be separately charged for a cosmetic procedure regardless of the amount of upper eyelid skin that is removed on a patient receiving a blepharoptosis repair because removal of any amount of upper eyelid skin is part of the blepharoptosis repair. In addition, the following are not permitted:

CMS Pub-100 (update for ASC - Eff Oct 2017)

– Noridian Healthcare Solutions (July 2016 Update)

References:

Upper Eyelid Blepharoplasty and Blepharoptosis Repair (update eff 10/01/2017). (2016, October 3). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/upper-eyelid-blepharoplasty-and-blepharoptosis-repair-31587.html

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