Documentation Requirements Bilateral: Use modifier 50 for CPT codes 15822-15823, 67901-67904, 67906, and 67908 when performed bilaterally. Unilateral: Use modifier E1 (upper left eyelid) or E3 (upper right eyelid) for codes 15822-15823, 67901-67904, 67906, and 67908 when performed unilaterally.
What is the difference between CPT code 15822 and 15823?
The first code (CPT 15822) is used for normal blepharoplasties of the upper eyelid, whereas the second code (CPT 15823) is assigned when the patient has excessive skin weighing down the eyelid.
How do you bill a blepharoplasty?
Medicare does not require you to submit cosmetic surgery, such as blepharoplasty, CPT codes 15822-15823.
If the patient insists that you file a claim, submit 15822-15823 with modifier -GY.
Is a blepharoplasty ever medically necessary?
Blepharoplasty, blepharoptosis repair, or brow lift is considered cosmetic and not medically necessary when performed to improve an individual’s appearance in the absence of any signs or symptoms of functional abnormalities. Lower lid blepharoplasty is considered cosmetic and not medically necessary.
Does Medicare pay for a brow lift?
Medicare does not offer coverage for cosmetic surgery. But the program does pay for eyelid lifts, known as blepharoplasty, when a patient’s sagging eyelids hinder their vision. Medicare reimbursement for eyelid surgery ranges from $574 to $640 per eye—not exactly a big ticket item.
Does insurance cover hooded eyelid surgery?
Eyelid surgery can also remove loose skin and tissue on the lower eyelids that create puffy bags under the eyes. When performed solely for cosmetic reasons, eyelid surgery is considered to be elective and therefore cannot be covered by medical insurance.
Does insurance pay for droopy eyelid surgery?
Lower eyelid blepharoplasty is never covered by insurance. Proper diagnosis and documentation is crucial in improving the chance that your insurance company will cover the surgery. Visual field testing documents the degree to which the excess eyelid skin obscures your vision.
Can You Bill 67904 with 15823 as a modifier?
15823 is mutually exclusive to 67904 however a modifier is allowed. (like if it is on the other eye.) That is what I thought. Thanks for your help. I disagree, you should be able to bill both as long as both are documented. See below from August 2011 issue of CPT assistant.
What are the criteria for CPT 15823, 67904?
Reasonably complete information fulfilling the criteria in Section A (Patient Complaints and Physical Signs), and Section B (Photographs) as delineated below must be adequately documented in the patient’s medical records to demonstrate the reasonableness and necessity of the procedure (s) performed.
Do you need CPT code 15822 for blepharoplasty?
Medicare does not require you to submit cosmetic surgery, such as blepharoplasty, CPT codes 15822-15823. If the patient insists that you file a claim, submit 15822-15823 with modifier -GY.