PDF Cosmetic and Reconstructive Surgery Procedures
MEDICAL POLICY No. 91535-R3 Cosmetic and Reconstructive Surgery Procedures Page 2 of 15 III. Blepharoptosis/Brow Ptosis Repair A. Blepharoplasty is a covered benefit only when necessary due to functional impairment (visual field obstruction) only when the indications below are met: ................
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