Blepharoplasty
J15 · Effective Oct 1, 2015
18 active Medicare policies list 67904, and 14 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J15 · Effective Oct 1, 2015
JE · Effective Oct 1, 2015
JF · Effective Oct 1, 2015
J5 · Effective Oct 1, 2015
J8 · Effective Oct 1, 2015
J9 · Effective Oct 1, 2015
JH · Effective Oct 1, 2015
JL · Effective Oct 1, 2015
JJ · Effective Oct 1, 2015
14 policies from 11 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 67904 |
|---|---|---|
| Blepharoplasty, Reconstructive Eyelid Surgery, and Brow Lift | Jun 15, 2026 | Covered with conditions |
| Cigna Commercial Other Services Code List - Effective 03/07/2026 | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List - Effective 03/07/2026 | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 67904 |
|---|---|---|
| Blepharoplasty, Repair of Blepharoptosis, and Brow Ptosis Repair | Aug 1, 2026 | Covered |
JM · Effective Oct 1, 2015
National · Effective Nov 6, 2025
J5 · Effective Jan 1, 2026
J9 · Effective Jan 1, 2025
JL · Effective Jan 1, 2025
National · Effective Jan 1, 2025
National · Effective Oct 16, 2025
National · Effective Jan 1, 2025
J6 · Effective Jan 1, 2025
| Gender Affirming Interventions for Gender Dysphoria | Apr 1, 2026 | Covered |
|---|
| Policy | Effective | Status of 67904 |
|---|---|---|
| Blepharoplasty, Blepharoptosis Repair, and Brow Lift | Jan 6, 2026 | Covered |
| Policy | Effective | Status of 67904 |
|---|---|---|
| Blepharoplasty and Blepharoptosis | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 67904 |
|---|---|---|
| Blepharoplasty and Blepharoptosis | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 67904 |
|---|---|---|
| Blepharoplasty and Blepharoptosis | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 67904 |
|---|---|---|
| Blepharoplasty and Blepharoptosis | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 67904 |
|---|---|---|
| Blepharoplasty, Blepharoptosis Repair and Brow Lift | Sep 1, 2026 | Covered |
| Policy | Effective | Status of 67904 |
|---|---|---|
| Brow Ptosis and Eyelid Repair | Aug 1, 2026 | Covered |
| Policy | Effective | Status of 67904 |
|---|---|---|
| Brow Ptosis and Eyelid Repair | Aug 1, 2026 | Covered |
| Policy | Effective | Status of 67904 |
|---|---|---|
| Brow Ptosis and Eyelid Repair | Aug 1, 2026 | Covered |