Blepharoplasty of upper lids
Commercial group HMO, EPO, POS and PPO plans
Commercial individual MyPriority® plans
Priority Health Choice plans (Medicaid and Healthy Michigan Plan)
Priority Health Medicare plans
Blepharoplasty is the surgical removal of excess fat, muscle and/or skin from the eyelids or from under the eyes.
Blepharoplasty of the upper eyelids is covered only when necessary due to functional impairment. See the criteria in the medical policy.
If/when commercial employer group and MyPriority® individual plans cover certain surgeries, these surgeries are covered at a different cost-sharing level than our standard benefit coverage levels.
To verify member cost sharing, use the Member Inquiry tool and look in the Additional benefits drop-down menu for Certain surgeries benefit information.
Required for some plans: See our Authorization reference list. Use the Auth Request online authorization tool.
See the medical policy for codes that may apply and codes not covered.