Medicare AdvantageCoverageMedium impact
Blepharoplasty, Blepharoptosis Repair and Brow Lift - Medicare Advantage (Revised)
Humana·Ophthalmology, Plastic Surgery·Medicare Advantage
Effective date
Sep 1, 2026
We identified it
Aug 28, 2026
Summary
Humana Medicare Advantage has revised its coverage policy for blepharoplasty, blepharoptosis repair, and brow lift procedures effective 09/01/2026. The policy clarifies medical necessity criteria for specific procedures (overcorrection reduction, eyelid retraction, ectropion/entropion repair) and establishes standardized canthoplasty coverage requirements across all jurisdictions. Billing teams must ensure claims for these procedures include proper medical necessity documentation and align with MAC-specific LCDs by jurisdiction.
Action Required
By 08/15/2026: (1) Billing and clinical teams must review the jurisdiction-specific MAC LCDs listed in the policy (L34528, L33944, L34194, L35004, L34411, L34028) for your practice location. (2) Update billing system and EMR templates to require documented medical necessity for CPT codes 67909, 67911, 67914, 67916, 67917, 67921, 67923, 67924 (based on LCD L33944 criteria) and CPT 67950 (canthoplasty - must document one of three specific clinical scenarios: conjunction with ectropion/entropion repair, restoration of function to prevent corneal/conjunctival exposure, or eyelid reconstruction post-tumor excision). (3) Ensure providers document visual field obstruction, functional impairment, or reconstruction need rather than cosmetic indications. (4) Implement pre-claim review to verify each canthoplasty includes one of the three required clinical justifications or claims will be denied as cosmetic surgery per Medicare exclusion 42 CFR §411.15. (5) Clarify with providers that therapeutic procedures with coincidental cosmetic benefit ARE covered, but purely cosmetic procedures remain excluded.