MedicaidCoverageMedium impact
Eyebrow and Eyelid Repair - MEDICAID - FLORIDA (Revised)
Humana·FL · Ophthalmology, Plastic Surgery·Medicaid
Effective date
Dec 15, 2025
We identified it
Jun 24, 2026
Summary
Humana Florida Medicaid updated coverage criteria for eyebrow and eyelid repair procedures, establishing specific documentation and clinical requirements for brow lifts, eyelid retraction correction, and floppy eyelid syndrome repair. The policy clarifies that these procedures are only covered when strict medical necessity criteria are met, otherwise they are considered cosmetic.
Action Required
Before December 15, 2025: Billing team must update prior authorization requirements for CPT codes 67900, 67909, 67911, 67961, and 67966 for Florida Medicaid patients. Providers must obtain frontal photographs documenting brow drooping, verify specific clinical measurements (2.0mm or less pseudo-margin reflex distance), and document failure of conservative treatments before submitting claims. Update encounter forms to include required documentation checklists for these procedures.