Here are the diagnosis codes typically associated with medically necessary blepharoplasties.  We also provide some helpful dermatology coding tips in making Medicare or your insurance carrier cover your procedures.

Prior to performing a blepharoplasty, the patient would need to have a visual examination by either an Optometrist or Ophthalmologist.  E&M Codes: 92081-92083 (Visual Examination, unilateral or bilateral, with interpretation and report) This is where having a good relationship with a local optometrist or ophthalmologist can be helpful.  You want to refer the patient to someone that will be reliable in quickly providing you with the needed documentation.  Once deemed medically necessary, follow the coding tips below.

CPT Codes for Blepharoplasty:

15822 (upper eyelid)

15823 (lower eyelid)- It is highly improbable that you will be able to prove medical necessity for lower eyelids.

Modifiers Used: E1 (Upper Left Lid), E3 (Upper Right Lid) or Modifier 50- (Bilateral Procedure)

ICD-9 Codes Used:

  • 373.4- Infective Dermatitis of eyelid of types resulting in deformity
  • 373.5- Other infective dermatitis of eyelid
  • 373.6- Parasitic infestation of eyelid
  • 374.30-Ptosis of eyelid, unspecified
  • 374.31- Paralytic ptosis
  • 374.32- Myogenic ptosis
  • 374.33- Mechanical ptosis
  • 374.34- Blepharochalasis
  • 374.87- Dermatochalasis
  • 374.89- Other disorders of eyelid
  • 743.61- Congenital ptosis of eyelid
  • 743.62- Cngenital ptosis of eyelid
  • 743.63- Other specified congenital deformities of eyelid
  • V52.2- Fitting and adjustment of artificial eye

Reimbursement:

The average reimbursement for the blepharoplasty procedure by Medicare is around $900.00 depending on your region.


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