Blepharoplasty, Reconstructive Eyelid Surgery, and… | Cigna

Blepharoplasty, Reconstructive Eyelid Surgery, and Brow Lift

Cigna · PayerPolicy · CIGNA-0045

Status: Active
Effective: June 15, 2026
Last checked by Backwork: October 1, 2026

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

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Codes in this policy

Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
15820	CPT	Covered with conditions
15821	CPT	Covered with conditions
15822	CPT	Covered with conditions
15823	CPT	Covered with conditions
67900	CPT	Covered with conditions
67901	CPT	Covered with conditions
67902	CPT	Covered with conditions
67903	CPT	Covered with conditions
67904	CPT	Covered with conditions
67905	CPT	Covered with conditions
67906	CPT	Covered with conditions
67907	CPT	Covered with conditions
67908	CPT	Covered with conditions
67911	CPT	Covered with conditions
67914	CPT	Covered with conditions
67915	CPT	Covered with conditions
67916	CPT	Covered with conditions
67917	CPT	Covered with conditions
67918	CPT	Covered with conditions
67919	CPT	Covered with conditions
67920	CPT	Covered with conditions
67921	CPT	Covered with conditions
67922	CPT	Covered with conditions
67923	CPT	Covered with conditions
67924	CPT	Covered with conditions