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Medicare bans Cosmetic Upper Eyelid Surgery when a medical necessary one is being performed (Even if

Want to get out of glasses when you get cataract surgery? No problem. Want to have a liposuction when you get skin cancer removed? No problem. Want to get rid of excess eyelid skin when you get your eyelids lifted because you can’t see. Illegal. Medicare has now decided it is “illegal” to combine a cosmetic upper eyelid blepharoplasty with a ptosis repair. Surgeons who do so will be consider liable from Medicare and expose themselves to legal consequences for performing a cosmetic blepharoplasty with a ptosis repair, despite a patient wanting the procedure at the same time and willing to pay for it.

Usually when there is drooping of the eyelid (called ptosis), the eyelids can be lifted to improve the patients vision. This is done by tightening a muscle in the eyelid. This procedure raises the eyelid position. Often patients choose to get upper eyelid cosmetic blepharoplasty which involves removing excess skin and fat from the upper eyelid to reduce the signs of aging at the same time.Starting July 1, Medicare has recently decided that this combination of procedures is now “illegal” and doctors will be prosecuted for performing both procedures together.

The logic for this is stifling and as a Denver oculoplastic surgeon I am not sure exactly why Medicare would decide to ban the combination of procedures. Often medicare bundles procedures that are often combined however they have never before banned a procedure that the patient could elect to do at the same time and pay for on their own out of pocket. The reason is simple: reduce costs for medicare...who cares what the patient wants.

Medicare's recommendation is to have the patient come back three months after the ptosis repair and have the patient undergo the blepharoplasty then. This exposes a patient to a second procedure. Alternatively in the initial procedure the patient can hope the surgeon,hospital and anesthetist perform the cosmetic procedure at no charge for the patient. Certainly, the Center for Medicare Services doesn’t believe that surgeons, hospitals and anesthesiologists will perform cosmetic surgery for free so the implication is that they are hoping that maybe patients will elect to not undergo ptosis surgery at all if they can’t get their eyelids done at the same time. That reduces Medicares costs but is a huge diservice to patients as it forces them to undergo two separate procedures with two different recoveries, exposure to anesthesia and need for a family member to be there with them with the procedure.

As an eyelid specialist in Denver who commonly performs ptosis repair alone and with blepharoplasty, I am disappointed and shocked that Medicare would make the decision that supports their reduction of costs at the expense of patient welfare and benefit. Reducing costs is important but there are limits when it comes to patient safety and convenience. What would be the next steps? If you come in for an eye exam paid by Medicare, you can’t buy glasses over $200 from the doctor’s optical shop? Or if you go in for an OB-GYN appointment, you aren’t allowed to get Botox at the same time. I feel sorry for how our Medicare patients are being treated by the insurance that is supposed to protect them. This seem like a large overreach of a government run insurance plan even for a doctor who supports medicare and health insurance support for the US population. It seems that the doctors who speak of a slippery slope for too much power for government may have a point and I may have to reconsider my position.

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