Medicare AdvantageCoverageMedium impact
Blepharoplasty, Blepharoptosis Repair and Brow Lift - Medicare Advantage (Revised)
Humana·Ophthalmology, Plastic Surgery·Medicare Advantage
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their policy for blepharoplasty, blepharoptosis repair, and brow lift procedures, establishing medical necessity criteria for jurisdictions without Local Coverage Determinations (LCDs). The policy references LCD L33944 criteria for determining coverage and includes specific requirements for canthoplasty procedures.
Action Required
Before June 1, 2026: Billing team must review and update authorization requirements for eyelid and brow procedures for Humana Medicare Advantage patients. Verify jurisdiction-specific LCD requirements using the MAC table provided. For J6/JK jurisdictions (IL, MN, WI, CT, NY, ME, MA, NH, RI, VT), apply LCD L33944 criteria for medical necessity determinations. Update prior authorization workflows to include canthoplasty medical necessity criteria when performed with other eyelid procedures.