What Is Different about Medicare Coverage?

Medicare does not pay for everything. With Medicare, the decision to cover surgery is not made until after surgery when the claim is submitted from the doctor’s office. Medicare does not have a pre-approval (predetermination) process. Dr. Klapper will discuss with you whether your photographs and/or visual fields may, in his opinion, meet the specific criteria outlined by the local carrier for Medicare. Dr. Klapper can not, however, guarantee whether your surgery will be a covered service. Lower eyelid blepharoplasty surgery is rarely covered by Medicare and is considered cosmetic in almost all cases. A referral from your primary care physician or eye doctor does not insure that Medicare will cover your eyelid surgery. All Medicare patients considering functional blepharoplasty and/or ptosis surgery will be asked to sign Medicare’s Advance Beneficiary Notice of Noncoverage (ABN) indicating that you understand your financial responsibility if Medicare does not cover your surgery. Similarly, Medicare patients electing to proceed with blepharoplasty, ptosis, or brow/forehead lifting procedures that do not appear to meet Medicare’s criteria for medical necessity will also be asked to sign Medicare’s Advance Beneficiary Notice of Noncoverage (ABN) indicating that the procedure(s) is(are) considered cosmetic, non-covered service(s) and will not be filed with Medicare. Secondary insurance carriers generally follow Medicare guidance.  Klapper Eyelid & Facial Plastic Surgery Financial Policy