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Management of Dry Eye Syndrome and Meibomian Gland Dysfunction (e.g., LipiFlow) 9.01.19
Effective date
Dec 18, 2025
Identified
Jun 20, 2026
Summary
Excellus BlueCross BlueShield medical policy 9.01.19 considers eyelid thermal pulsation therapy to treat dry eye syndrome investigational, including LipiFlow, iLux System, TearCare and Tixel i. It also considers tear film imaging with the LipiView Ocular Surface Interferometer, used to evaluate dry eye syndrome and meibomian gland dysfunction, and near-infrared dual imaging with the LipiScan Dynamic Meibomian Imager, used to evaluate meibomian glands, investigational. The current effective date is December 18, 2025, and the December 18, 2025 annual review states that policy intent is unchanged.
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What to do
Action · 3 steps
01Already effective December 18, 2025: Billing team should check the member's subscriber contract before billing CPT 0207T, 0330T, 0507T or 0563T, because eligibility for reimbursement is based on the benefits in that contract and services are contract dependent.
02The policy marks these codes as experimental or investigational (E/I), and codes may not be covered under all circumstances.
03Confirm with the payer that this policy version is still current before billing these services.
Codes mentioned
H02.8H04.121H04.129
Original notice
Management of Dry Eye Syndrome and Meibomian Gland Dysfunction (e.g., LipiFlow) 9.01.19
excellusbcbs.com · Always check the source before changing claims.