Eyelid-Lift Payments From Medicare Rise, And Raise Eyebrows

By Bill Chappell

Published May 28, 2013 at 1:45 PM EDT

The number of eyelid lifts reimbursed by Medicare more than tripled from 2001 to 2011, according to the Center for Public Integrity. Here, a woman is prepared for the procedure, along with an eyebrow lift.

The number of eyelid lifts paid for by Medicare more than tripled in a 10-year span, according to a report by the Center for Public Integrity. The cost to U.S. taxpayers for the simple surgery rose to $80 million in 2011 from $20 million in 2001, according to the report.

"From 2001 to 2011, eyelid lifts charged to Medicare more than tripled to 136,000 annually, according to a review of physician billing data by the Center for Public Integrity," write the Center's Joe Eaton and David Donald.

In one year, they add, a Florida plastic surgeon billed Medicare for $800,000, after performing about 2,200 procedures.

While the federal health insurance program doesn't pay for cosmetic surgery, it does cover "surgery for therapeutic purposes which coincidentally also serves some cosmetic purpose," according to its rules.

In the case of eyelid surgery, the therapeutic or functional purpose is to improve the patient's field of vision by removing skin and fat that sags around the eyes. Drooping eyelids "occur naturally with increasing age. However, some people are born with droopy eyelids or develop diseases (such as myasthenia gravis) that cause eyelid drooping," according to the National Institutes of Health.

But the sharp rise in the popularity of eyelid surgery is prompting questions about whether Medicare is stringent enough in determining when to reimburse patients for the surgery. According to the Center for Public Integrity, the criteria include performing two sets of eye exams — once with the skin around the patient's eyes taped back, and once without the tape.

"With this kind of management malpractice, it's little wonder that the [Medicare] program is in such dire shape," physician and Sen. Tom Coburn, R-Okla., tells the Center for Public Integrity. "The federal government is essentially asking people to game the system."

Often performed as outpatient surgery or in a doctor's office, most eyelid lifts (formally known as blepharoplasty) require only local anesthesia. Some doctors also administer an anti-anxiety drug before the surgery, which lasts less than one hour. The range of Medicare's payments is from $574 to $640 per eye, according to the report.

"The more alert and youthful look usually lasts for years. These results are permanent for many people," writes the NIH.

For their report, the Center for Public Integrity's Eaton and Donald spoke with physicians who said the procedure had improved the lives of their patients, who may not have realized how much their drooping eyelids have affected their field of vision. But other surgeons also said they had been pressured by patients who wanted federal help in paying for the surgery.

"Surgeons who bill Medicare for large numbers of eyelid surgeries dot a map of the United States," they write. "Yet 11 of the 20 highest billers in 2008 were in Florida, which is both an elderly mecca and the country's foremost magnet for questionable Medicare billing."