This will be a rare complex chart review for physicians in all states save those covered by CGI. That recovery auditor hasn’t posted this target for doctors, but we’ll be surprised if it doesn’t follow its fellow auditors.
Here is the target detail from Performant, the auditor that covers RAC region A: “Blepharoplasty is the plastic repair of the eyelid, and usually refers to an operation in which redundant skin, muscle, and/or fat are excised. Functional blepharoplasty usually involves the excision of skin and orbicularis muscle. This procedure is usually done to correct a deficit in the upper or peripheral field of vision or as noted on forward gaze by skin resting on the upper eyelashes. When blepharoplasty repair is done for cosmetic purposes it does not meet the criteria of the functional visual impairment parameters and is considered not reasonable and medical necessary and therefore will denied.”