Upper Eyelid Blepharoplasty and Blepharoptosis Repair

Date Issued: 8/30/2016

As of July 1, 2016, in accordance with the Centers for Medicare and Medicaid Services, EmblemHealth no longer allows separate payment for blepharoplasty procedures (CPT codes 15822 and 15823) when billed in addition to blepharoptosis procedures (CPT codes 67901-67908) performed on the ipsilateral upper eyelid. Any removal of upper eyelid skin in the context of upper eyelid blepharoptosis surgery is considered part of the blepharoptosis surgery.

The removal of orbital fat (CPT 67400) - when a blepharoplasty or a blepharoptosis repair is performed - will also no longer be separately reimbursed.

The use of modifier 59 will not override any bundling denials.