Local Coverage Article Billing and Coding

Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift

A56503

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Article ID
A56503
Article Title
Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift
Article Type
Billing and Coding
Original Effective Date
04/18/2019
Revision Effective Date
04/22/2021
Revision Ending Date
N/A
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

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CMS Manual System, Pub 100-04 Medicare Claims Processing Manual, Transmittal 3552, Change Request 9658.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Blepharoplasty, Eyelid Surgery, and Brow Lift L34411.

 

 

Coding Information

CPT/HCPCS Codes

Group 1

(11 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
15820 Revision of lower eyelid
15821 Revision of lower eyelid
15822 Revision of upper eyelid
15823 Revision of upper eyelid
67900 Repair brow defect
67901 Repair eyelid defect
67902 Repair eyelid defect
67903 Repair eyelid defect
67904 Repair eyelid defect
67906 Repair eyelid defect
67908 Repair eyelid defect

Group 2

(11 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
CodeDescription
67909 Revise eyelid defect
67911 Revise eyelid defect
67912 Correction eyelid w/implant
67914 Repair eyelid defect
67915 Repair eyelid defect
67916 Repair eyelid defect
67917 Repair eyelid defect
67921 Repair eyelid defect
67922 Repair eyelid defect
67923 Repair eyelid defect
67924 Repair eyelid defect

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(40 Codes)
Group 1 Paragraph

It is the responsibility of the physician/provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10 code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

For Blepharoptosis Repair, Blepharoplasty, and Browplasty:

 

Group 1 Codes
CodeDescription
G24.5 Blepharospasm
G51.2 Melkersson's syndrome
G51.31 Clonic hemifacial spasm, right
G51.32 Clonic hemifacial spasm, left
G51.4 Facial myokymia
G70.00 Myasthenia gravis without (acute) exacerbation
G70.80 Lambert-Eaton syndrome, unspecified
G70.81 Lambert-Eaton syndrome in disease classified elsewhere
G73.1 Lambert-Eaton syndrome in neoplastic disease
H02.31 Blepharochalasis right upper eyelid
H02.32 Blepharochalasis right lower eyelid
H02.34 Blepharochalasis left upper eyelid
H02.35 Blepharochalasis left lower eyelid
H02.401 Unspecified ptosis of right eyelid
H02.402 Unspecified ptosis of left eyelid
H02.403 Unspecified ptosis of bilateral eyelids
H02.411 Mechanical ptosis of right eyelid
H02.412 Mechanical ptosis of left eyelid
H02.413 Mechanical ptosis of bilateral eyelids
H02.421 Myogenic ptosis of right eyelid
H02.422 Myogenic ptosis of left eyelid
H02.423 Myogenic ptosis of bilateral eyelids
H02.431 Paralytic ptosis of right eyelid
H02.432 Paralytic ptosis of left eyelid
H02.433 Paralytic ptosis of bilateral eyelids
H02.521 Blepharophimosis right upper eyelid
H02.522 Blepharophimosis right lower eyelid
H02.524 Blepharophimosis left upper eyelid
H02.525 Blepharophimosis left lower eyelid
H02.70 Unspecified degenerative disorders of eyelid and periocular area
H02.831 Dermatochalasis of right upper eyelid
H02.832 Dermatochalasis of right lower eyelid
H02.834 Dermatochalasis of left upper eyelid
H02.835 Dermatochalasis of left lower eyelid
H57.811 Brow ptosis, right
H57.812 Brow ptosis, left
H57.813 Brow ptosis, bilateral
L57.4 Cutis laxa senilis
L85.8 Other specified epidermal thickening
Q10.0 Congenital ptosis

Group 2

(152 Codes)
Group 2 Paragraph

For Other Eyelid Surgeries:

Group 2 Codes
CodeDescription
C43.111 Malignant melanoma of right upper eyelid, including canthus
C43.112 Malignant melanoma of right lower eyelid, including canthus
C43.121 Malignant melanoma of left upper eyelid, including canthus
C43.122 Malignant melanoma of left lower eyelid, including canthus
C4A.111 Merkel cell carcinoma of right upper eyelid, including canthus
C4A.112 Merkel cell carcinoma of right lower eyelid, including canthus
C4A.121 Merkel cell carcinoma of left upper eyelid, including canthus
C4A.122 Merkel cell carcinoma of left lower eyelid, including canthus
C44.1021 Unspecified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1022 Unspecified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1091 Unspecified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1092 Unspecified malignant neoplasm of skin of left lower eyelid, including canthus
C44.1121 Basal cell carcinoma of skin of right upper eyelid, including canthus
C44.1122 Basal cell carcinoma of skin of right lower eyelid, including canthus
C44.1191 Basal cell carcinoma of skin of left upper eyelid, including canthus
C44.1192 Basal cell carcinoma of skin of left lower eyelid, including canthus
C44.1221 Squamous cell carcinoma of skin of right upper eyelid, including canthus
C44.1222 Squamous cell carcinoma of skin of right lower eyelid, including canthus
C44.1291 Squamous cell carcinoma of skin of left upper eyelid, including canthus
C44.1292 Squamous cell carcinoma of skin of left lower eyelid, including canthus
C44.1321 Sebaceous cell carcinoma of skin of right upper eyelid, including canthus
C44.1322 Sebaceous cell carcinoma of skin of right lower eyelid, including canthus
C44.1391 Sebaceous cell carcinoma of skin of left upper eyelid, including canthus
C44.1392 Sebaceous cell carcinoma of skin of left lower eyelid, including canthus
C44.1921 Other specified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1922 Other specified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1991 Other specified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1992 Other specified malignant neoplasm of skin of left lower eyelid, including canthus
C44.301 Unspecified malignant neoplasm of skin of nose
C44.309 Unspecified malignant neoplasm of skin of other parts of face
C44.311 Basal cell carcinoma of skin of nose
C44.319 Basal cell carcinoma of skin of other parts of face
C44.321 Squamous cell carcinoma of skin of nose
C44.329 Squamous cell carcinoma of skin of other parts of face
C44.391 Other specified malignant neoplasm of skin of nose
C44.399 Other specified malignant neoplasm of skin of other parts of face
C47.0 Malignant neoplasm of peripheral nerves of head, face and neck
C49.0 Malignant neoplasm of connective and soft tissue of head, face and neck
D03.111 Melanoma in situ of right upper eyelid, including canthus
D03.112 Melanoma in situ of right lower eyelid, including canthus
D03.121 Melanoma in situ of left upper eyelid, including canthus
D03.122 Melanoma in situ of left lower eyelid, including canthus
D04.111 Carcinoma in situ of skin of right upper eyelid, including canthus
D04.112 Carcinoma in situ of skin of right lower eyelid, including canthus
D04.121 Carcinoma in situ of skin of left upper eyelid, including canthus
D04.122 Carcinoma in situ of skin of left lower eyelid, including canthus
D22.111 Melanocytic nevi of right upper eyelid, including canthus
D22.112 Melanocytic nevi of right lower eyelid, including canthus
D22.121 Melanocytic nevi of left upper eyelid, including canthus
D22.122 Melanocytic nevi of left lower eyelid, including canthus
D22.39 Melanocytic nevi of other parts of face
D23.111 Other benign neoplasm of skin of right upper eyelid, including canthus
D23.112 Other benign neoplasm of skin of right lower eyelid, including canthus
D23.121 Other benign neoplasm of skin of left upper eyelid, including canthus
D23.122 Other benign neoplasm of skin of left lower eyelid, including canthus
D23.39 Other benign neoplasm of skin of other parts of face
G51.0 Bell's palsy
G51.2 Melkersson's syndrome
H01.001 Unspecified blepharitis right upper eyelid
H01.002 Unspecified blepharitis right lower eyelid
H01.004 Unspecified blepharitis left upper eyelid
H01.005 Unspecified blepharitis left lower eyelid
H02.001 Unspecified entropion of right upper eyelid
H02.002 Unspecified entropion of right lower eyelid
H02.004 Unspecified entropion of left upper eyelid
H02.005 Unspecified entropion of left lower eyelid
H02.011 Cicatricial entropion of right upper eyelid
H02.012 Cicatricial entropion of right lower eyelid
H02.014 Cicatricial entropion of left upper eyelid
H02.015 Cicatricial entropion of left lower eyelid
H02.021 Mechanical entropion of right upper eyelid
H02.022 Mechanical entropion of right lower eyelid
H02.024 Mechanical entropion of left upper eyelid
H02.025 Mechanical entropion of left lower eyelid
H02.031 Senile entropion of right upper eyelid
H02.032 Senile entropion of right lower eyelid
H02.034 Senile entropion of left upper eyelid
H02.035 Senile entropion of left lower eyelid
H02.041 Spastic entropion of right upper eyelid
H02.042 Spastic entropion of right lower eyelid
H02.044 Spastic entropion of left upper eyelid
H02.045 Spastic entropion of left lower eyelid
H02.051 Trichiasis without entropion right upper eyelid
H02.052 Trichiasis without entropion right lower eyelid
H02.054 Trichiasis without entropion left upper eyelid
H02.055 Trichiasis without entropion left lower eyelid
H02.101 Unspecified ectropion of right upper eyelid
H02.102 Unspecified ectropion of right lower eyelid
H02.104 Unspecified ectropion of left upper eyelid
H02.105 Unspecified ectropion of left lower eyelid
H02.111 Cicatricial ectropion of right upper eyelid
H02.112 Cicatricial ectropion of right lower eyelid
H02.114 Cicatricial ectropion of left upper eyelid
H02.115 Cicatricial ectropion of left lower eyelid
H02.121 Mechanical ectropion of right upper eyelid
H02.122 Mechanical ectropion of right lower eyelid
H02.124 Mechanical ectropion of left upper eyelid
H02.125 Mechanical ectropion of left lower eyelid
H02.131 Senile ectropion of right upper eyelid
H02.132 Senile ectropion of right lower eyelid
H02.134 Senile ectropion of left upper eyelid
H02.135 Senile ectropion of left lower eyelid
H02.141 Spastic ectropion of right upper eyelid
H02.142 Spastic ectropion of right lower eyelid
H02.144 Spastic ectropion of left upper eyelid
H02.145 Spastic ectropion of left lower eyelid
H02.151 Paralytic ectropion of right upper eyelid
H02.152 Paralytic ectropion of right lower eyelid
H02.154 Paralytic ectropion of left upper eyelid
H02.155 Paralytic ectropion of left lower eyelid
H02.201 Unspecified lagophthalmos right upper eyelid
H02.202 Unspecified lagophthalmos right lower eyelid
H02.204 Unspecified lagophthalmos left upper eyelid
H02.205 Unspecified lagophthalmos left lower eyelid
H02.211 Cicatricial lagophthalmos right upper eyelid
H02.212 Cicatricial lagophthalmos right lower eyelid
H02.214 Cicatricial lagophthalmos left upper eyelid
H02.215 Cicatricial lagophthalmos left lower eyelid
H02.21A Cicatricial lagophthalmos right eye, upper and lower eyelids
H02.21B Cicatricial lagophthalmos left eye, upper and lower eyelids
H02.21C Cicatricial lagophthalmos, bilateral, upper and lower eyelids
H02.221 Mechanical lagophthalmos right upper eyelid
H02.222 Mechanical lagophthalmos right lower eyelid
H02.224 Mechanical lagophthalmos left upper eyelid
H02.225 Mechanical lagophthalmos left lower eyelid
H02.22A Mechanical lagophthalmos right eye, upper and lower eyelids
H02.22B Mechanical lagophthalmos left eye, upper and lower eyelids
H02.22C Mechanical lagophthalmos, bilateral, upper and lower eyelids
H02.231 Paralytic lagophthalmos right upper eyelid
H02.232 Paralytic lagophthalmos right lower eyelid
H02.234 Paralytic lagophthalmos left upper eyelid
H02.235 Paralytic lagophthalmos left lower eyelid
H02.23A Paralytic lagophthalmos right eye, upper and lower eyelids
H02.23B Paralytic lagophthalmos left eye, upper and lower eyelids
H02.23C Paralytic lagophthalmos, bilateral, upper and lower eyelids
H02.531 Eyelid retraction right upper eyelid
H02.532 Eyelid retraction right lower eyelid
H02.534 Eyelid retraction left upper eyelid
H02.535 Eyelid retraction left lower eyelid
H02.70 Unspecified degenerative disorders of eyelid and periocular area
H04.521 Eversion of right lacrimal punctum
H04.522 Eversion of left lacrimal punctum
H04.523 Eversion of bilateral lacrimal punctum
H50.89 Other specified strabismus
P11.3 Birth injury to facial nerve
Q10.1 Congenital ectropion
Q10.2 Congenital entropion
Q10.3 Other congenital malformations of eyelid
S04.51XD Injury of facial nerve, right side, subsequent encounter
S04.51XS Injury of facial nerve, right side, sequela
S04.52XD Injury of facial nerve, left side, subsequent encounter
S04.52XS Injury of facial nerve, left side, sequela

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
04/22/2021 R3

Under CMS National Coverage Policy added description to regulation Title XVIII of the Social Security Act, §1833(e).

10/10/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Blepharoplasty, Eyelid Surgery, and Brow Lift L34411 LCD and placed in this article. Formatting, punctuation and typographical errors were corrected throughout the article.

 

04/18/2019 R1

All coding located in the Coding Information section has been removed from the related Blepharoplasty, Eyelid Surgery, and Brow Lift L34411 Local Coverage Determination (LCD) and added to this article.

 

Associated Documents

Related Local Coverage Documents
LCDs
L34411 - Blepharoplasty, Eyelid Surgery, and Brow Lift
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
04/12/2021 04/22/2021 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Blepharoplasty, Eyelid Surgery, and Brow Repair
  • Blepharoplasty
  • Eyelid Surgery
  • Brow Repair