High impact
Brow Ptosis and Eyelid Repair (for Idaho Only)
UnitedHealthcare·Effective Oct 1, 2026
UnitedHealthcare Community Plan of Idaho (Medicaid) revised coverage criteria for eyelid and brow ptosis repair procedures effective October 1, 2026. Key changes include: (1) lower eyelid blepharoplasty is now explicitly considered reconstructive under certain circumstances, (2) lid retraction surgery (CPT 67911) for thyroid eye disease now has separate, expanded medical necessity criteria, and (3) new specific documentation requirements for floppy eyelid syndrome repair including photographic evidence and detailed clinical findings. Billing teams must update prior authorization processes and documentation checklists to reflect these narrower, condition-specific criteria.