H57.813 coverage policies: Medicare and commercial payers

24 active Medicare policies list H57.813, and 2 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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Medicare policies listing H57.813

LCD · CGS-J15-L33944

Blepharoplasty

J15 · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34194

Blepharoplasty, Eyelid Surgery, and Brow Lift

JE · Effective Oct 1, 2015

LCD · NORIDIAN-JF-L34194

Blepharoplasty, Eyelid Surgery, and Brow Lift

JF · Effective Oct 1, 2015

LCD · WPS-J5-L34528

Blepharoplasty, Blepharoptosis and Brow Lift

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L34528

Blepharoplasty, Blepharoptosis and Brow Lift

J8 · Effective Oct 1, 2015

LCD · FIRST_COAST-L34028

Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow

J9 · Effective Oct 1, 2015

LCD · NOVITAS-JH-L35004

Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow

JH · Effective Oct 1, 2015

LCD · NOVITAS-JL-L35004

Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow

JL · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34411

Blepharoplasty, Eyelid Surgery, and Brow Lift

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34411

Commercial payer policies listing H57.813

2 policies from 1 payer

Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.

Ambetter

Ambetter policies listing H57.813, with the code’s status in each
Policy	Effective	Status of H57.813
External Ocular PhotographyPayerPolicy · AMBETTER-CP-VP-43	Not recorded	Covered
Visual Field TestingPayerPolicy · AMBETTER-CP-VP-63	Not recorded	Covered