Blog Post

Medicare coverage for eye lifts raises eyebrows

May 30, 2013

    Hanna Jaquith, Daily Briefing

    The number of Medicare patients undergoing surgery for drooping eyelids has more than tripled over the last decade, leaving many to wonder if taxpayers are footing the bill for seniors' pursuit of youth.

    Medicare does not offer coverage for cosmetic surgery. But the program does pay for eyelid lifts, known as blepharoplasty, when a patient's sagging eyelids hinder their vision. Medicare reimbursement for eyelid surgery ranges from $574 to $640 per eye—not exactly a big ticket item. Yet, given the rapid rise in the number of so-called functional eyelid lifts, the dollars quickly add up.  

    From 2001 to 2011, eyelid lifts billed to Medicare more than tripled to 136,000 annually, according to a review of physician billing data by the Center for Public Integrity. Over the same period, the procedure's costs rose from a total of $20 million to $80 million, and the number of physicians billing for the surgery more than doubled.

    "With this kind of management malpractice, it's little wonder that the [Medicare] program is in such dire shape," Oklahoma Sen. Tom Coburn (R) says, adding, "The federal government is essentially asking people to game the system."

    Plastic surgeons say there are plenty of legitimate reasons for the spike, including the tendency of seniors to delay seeking medical help. However, surgeons also acknowledge the increase in popularity of the surgery fueled by reality TV, word-of-mouth referrals, and advertising, complete with dramatic—and often questionable—before and after photos.

    Plus, Medicare isn't exactly eagle-eyed when it comes to detecting and preventing fraudulent billing for eyelift procedures.

    The program does not require pre-authorization of the surgery; physicians are just required to confirm that a patient's drooping skin is compromising his or her vision. The process is easier said than done, particularly when it comes to overly pushy patients, says Michael Migliori, president of the American Society of Ophthalmic Plastic and Reconstructive Surgery. "They come in begging you to do this surgery," he says, adding, "You get a lot of pressure to bend the rules."

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