MedicaidCoverageHigh impact
Eyebrow and Eyelid Repair - MEDICAID - VIRGINIA (Revised)
Humana·VA · Ophthalmology, Plastic Surgery·Medicaid
Effective date
Dec 3, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Virginia has established new coverage criteria for eyebrow and eyelid repair procedures, requiring specific documentation including photographs and medical necessity criteria for CPT codes 67900, 67909, 67911, 67961, and 67966. Procedures not meeting these criteria will be considered cosmetic and denied.
Action Required
Before December 3, 2025: Billing team must update prior authorization requirements for eyebrow and eyelid repair procedures (CPT 67900, 67909, 67911, 67961, 67966) for Humana Medicaid Virginia members. Providers must obtain frontal photographs documenting brow drooping, verify specific medical necessity criteria are met, and document failure of conservative treatment where required. Update encounter forms and EMR templates to ensure proper documentation. Claims without meeting specified criteria will be denied as cosmetic.