1 CMS. Superseded Local Coverage Determination (LCD): Blepharoplasty. (May 21, 2023). Retrieved from www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33803.
Does Medicare Cover Eyelid Surgery?
- January 12, 2024
- Reviewed by John Krahnert
Original Medicare and Medicare Advantage plans may cover medically necessary eyelid surgery. Medicare Advantage plans also feature an annual out-of-pocket spending limit, which Original Medicare doesn't offer.
Eyelid surgery (blepharoplasty) may be covered by Medicare if it is considered medically necessary and reconstructive (rather than cosmetic).
Medicare Advantage plans (Medicare Part C) cover eyelid surgery if it is considered medically necessary by your doctor, and they also offer an annual out-of-pocket spending limit, which Original Medicare (Part A and Part B) doesn't offer.
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When does Medicare cover blepharoplasty?
Typically, for eyelid surgery to be considered medically necessary, it must be for reconstructive purposes, such as:1
- You have drooping eyelids (ptosis) that causes visual impairment
- A trauma or another eye surgery caused defects to your eyelid
- You have painful symptoms due to abnormal contraction of the eyelid muscles (blepharospasm)
- You experience eyelid complications due to thyroid disease and nerve palsy
Be sure to check with your doctor before receiving services to see if your eyelid surgery will be covered by Medicare.
If your vision is not impaired, eyelid surgery is considered cosmetic and will not be covered by Medicare. Blepharoplasty may be covered by Medicare but typically requires prior authorization.
How much does eyelid surgery cost with Medicare?
According to the Centers for Medicare & Medicaid Services (CMS), Original Medicare beneficiaries pay an average of $289 out of pocket for eyelid surgery covered by Medicare at an ambulatory surgery center in 2023.
The average out-of-pocket cost for Medicare blepharoplasty in a hospital outpatient department in 2023 is $455.
These eyelid surgery Medicare costs don’t include physician fees. Also keep in mind that if you undergo more than one procedure, your out-of-pocket costs could change.
If you have a Medicare Advantage plan, your deductibles, copays. coinsurance and other costs may be different.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
