Medicare Advantage Medical Policy Updates

Blue Cross and Blue Shield of Nebraska is proud to work with our provider network to serve your patients, our members. We are updating several medical policies. Please review the changes and effective dates outlined here:

Important and urgent update effective June 1, 2026

As  of June 1, 2026, Blue Cross Blue Shield of Nebraska will no longer utilize Optum InterQual for our Medicare Advantage population, and we will use Millman Care Guidelines for Medicare Advantage.  We will continue to use InterQual for our Commercial population.
We understand that changes to criteria can impact practice patterns and documentation. Our goal is to make this transition as seamless as possible.

Medicare Advantage Medical Policies will follow National Coverage Determinations (NCD), Local Coverage Determinations (LCD), plan policies and MCG criteria starting  June 1, 2026.

New Medical Policies for Medicare Advantage

Medical Policy Number: M.58
Medical Policy: INTRACAMERAL IMPLANTS 
Effective Date:  6/1/2026 
Preauthorization Required: Yes

Codes: 0660T, 0661T, 63030
Policy Statement 

  1. One-time intracameral injection (bimatoprost (Durysta)) may be considered reasonable and necessary for the reduction of intraocular pressure (IOP) in members with open angle glaucoma or ocular hypertension (OHT) when ALL the following criteria are met:
    1. The patient is 18 years of age and older, AND  
    2. The patient has tried and failed or has intolerance to at least one topical ophthalmic prostaglandin (e.g., bimatoprost, lantanoprost, travaprost) AND  
    3. The patient has tried and failed or has intolerance or contraindication to at least one topical beta-adrenergic blocker (betaxolol, metipranolol, timolol), AND  
    4. The injection or implant will only be administered to the affected eye AND  
    5. The affected eye has not received prior treatment with bimatoprost (Durysta) AND  
    6. The dose does not exceed 10 mcg bimatoprost per affected eye.  
  2. One-time intracameral implant (travoprost (iDose TR) may be considered reasonable and necessary for the reduction of intraocular pressure (IOP) in members with open angle glaucoma or ocular hypertension (OHT) when ALL the following criteria are met:  
    1. The patient is 18 years of age and older AND  
    2. The patient has tried and failed or has intolerance to at least one topical ophthalmic prostaglandin (e.g., bimatoprost, lantanoprost, travaprost) AND  
    3. The patient has tried and failed or has intolerance or contraindication to at least one topical beta-adrenergic blocker (betaxolol, metipranolol, timolol) AND
    4. The injection or implant will only be administered to the affected eye AND  
    5. The affected eye has not received prior treatment with travoprost (iDose TR) AND 
    6. The dose does not exceed 75 mcg travoprost (iDose TR) per affected eye.  
  3. When the above criteria are not met, services are considered not reasonable and necessary.
  4. All other indications are considered not reasonable and necessary. 
Medical Policy Number: M.59
Medical Policy: REMOTE ELECTRICAL NEUROMODULATION FOR MIGRAINES
Effective Date:  6/1/2026 
Preauthorization Required: Yes

Codes: A4540
Policy Statement:

Initiation of Use

  1. Remote electrical neuromodulation (REN [e.g. Nerivio]) for the prevention and management of migraine may be considered reasonable and necessary individuals when the following criteria are met:  
    1. Individual is 18 years of age or older; AND  
    2. Headaches meet the International Classification of Headache Disorders (ICHD-3) diagnostic criteria for migraines with or without aura (see Policy Guidelines); AND
    3. The REN device will be used in the following clinical scenario:  
      For the prevention and management of migraine in individuals with 6 to 24 headache days (defined as a calendar day with headache regardless of severity or duration) per 28-day period in each of the 3 months preceding use of the REN device); AND  
    4. One of the following additional criteria must also be met:  
      1. Insufficient response, contraindication, or intolerance to 2 or more guideline-recommended preventive headache medications (e.g., anticonvulsants, antihypertensives, antidepressants, CGRP inhibitors); OR  
      2. Pregnancy, breastfeeding, or planning to conceive; OR  
      3. At risk for or have a history of medication overuse headache; OR  
      4. At risk for drug-drug interactions with medications for comorbid conditions.  
  2. Remote electrical neuromodulation for prevention AND MANAGEMENT of migraine outside of the above criteria is considered not reasonable and necessary (see Policy Guidelines Considerations).  

Continuation of Use

  1. Continued use of the REN device and/or accessories for the prevention and management of migraine is considered medically necessary in individuals when the following criteria are met:  
    1. Compliance with ongoing use; AND  
    2. Documentation of clinical benefit (see Policy Guidelines).  

Policy guidelines

Remote Electrical Neuromodulation Contraindications  
Nerivio is contraindicated in patients with uncontrolled epilepsy and patients with an active implantable medical device, such as a pacemaker, hearing aid implant, or any implanted electronic device. Nerivio has not been evaluated in patients with congestive heart failure, severe cardiac or cerebrovascular disease, pregnancy, or patients under the age of 8 years.

    Medical Policy Number:  M.60
    Medical Policy:  Irreversible Electroporation (IRE)
    Effective Date:  6/1/2026 
    Preauthorization Required: Yes

    Codes: 0600T, 0601T, 47384, 53899, 55877, 47399, 48999
    Policy Statement:

    1. Irreversible Electroporation (IRE), including the use of the Nanoknife is considered not reasonable and necessary for all indications, including but not limited to soft tissue or solid organs such as liver, pancreas, prostate, kidneys and catheter-based cardiac ablation (e.g. atrial fibrillation or ventricular arrhythmias).
    Medical Policy Number:  M.61
    Medical Policy Name:   Elective Aorta and Iliac Artery Aneurysm Repair 
    Effective Date:  06/01/2026
    Preauthorization Required:  Yes

    Codes: 33875 33877 33880 33881 33882 33883 33884 33886 34701 34702 34703 34704 34705 34706 34830 34831 34832 34841 34842 34843 34844 34845 34846 34847 34848 0994T 0995T
    Policy Statement:

    ABDOMINAL AORTIC ANEURYSM (AAA) REPAIR
    Open (Surgical) AAA Repair (34830 – 34832)

    1. Open (surgical) aneurysm repair (OAR) of a radiographically confirmed AAA may be considered reasonable and necessary when the following requirements are met:
      1. Absence of prohibitive perioperative mortality risk
         AND 
      2. Any of the following:
        1. Aneurysm diameter greater than or equal to 5 cm in a female OR 
        2. Aneurysm diameter greater than or equal to 5.5 cm in a male OR
        3. Aneurysm diameter growth rate confirmed by imaging (e.g., CT, MRI, TTE) is greater than or equal to 1 cm within 1 year or at least 0.5 cm within 6 months OR
        4. Aneurysm diameter less than 5 cm in a female or less than 5.5 cm in a male for an individual of short stature (eg, one or more standard deviations below mean height*) with shared decision making; OR
        5. Asymptomatic AAA associated with concomitant IAA that meets criteria for OAR IAA repair, OR 
        6. Individual requires chemotherapy, radiation therapy or solid organ transplant with aneurysm diameter 4 – 5.4 cm with shared decision-making OR
        7. Infectious aortitis with aneurysm; OR
        8. Marfan syndrome and a nondissected aneurysm diameter greater than or equal to 5 cm; OR
        9. Saccular aneurysm

    Endovascular Aneurysm Repair of AAA (34701 – 34706)

    1. Endovascular aneurysm repair (EVAR) of radiographically confirmed AAA may be considered reasonable and necessary when the following requirements are met:
      1. Any of the following:
        1. Aneurysm diameter greater than or equal to 5 cm in a female OR
        2. Aneurysm diameter greater than or equal to 5.5 cm in a male OR
        3. Aneurysm diameter growth rate confirmed by imaging (eg, CT, MRI, TTE) is greater than or equal to 1 cm within 1 year or at least 0.5 cm within 6 months OR
        4. Aneurysm diameter less than 5 cm in a female or less than 5.5 cm in a male for an individual of short stature (e.g., one or more standard deviations below mean height*) with shared decision-making  OR
        5. Asymptomatic AAA associated with concomitant IAA that meets criteria for EVAR IAA repair OR 
        6. Complications (e.g., endoleak) from a previously placed endograft OR
        7. Individual requires chemotherapy, radiation therapy or solid organ transplant with aneurysm diameter 4 – 5.4 cm and with shared decision-making OR 
        8. Saccular aneurysm
          AND
      2. Absence of the following contraindications:
        1. Known allergy or intolerance to device materials (eg, nitinol, platinum-iridium, polyester) AND
        2. Prohibitive perioperative mortality risk; AND
        3. Systemic infection

    Fenestrated Endovascular Aneurysm Repair of AAA (34841 – 34848) 

    1. Fenestrated endovascular aneurysm repair (FEVAR) of radiographically confirmed AAA may be considered reasonable and necessary when the following requirements are met:
      1. No ruptured AAA with moderate to high perioperative risk AND
      2. Suitable anatomy for an FDA-approved fenestrated endovascular device AND
      3. Absence of the following contraindications
        1. Infection, local or systemic; AND
        2. Known allergy or sensitivity to gold, nitinol, polyester, polypropylene solder (tin, silver) or stainless steel; AND
        3. Prohibitive perioperative mortality risk. 
          AND 
      4. Any of the following:
        1. Aneurysm diameter greater than or equal to 5 cm in a female OR
        2. Aneurysm diameter greater than or equal to 5.5 cm in a male OR
        3. Aneurysm diameter growth rate confirmed by imaging (eg, CT, MRI, TTE) is greater than or equal to 1 cm within 1 year or at least 0.5 cm within 6 months OR
        4. Aneurysm diameter less than 5 cm in a female or less than 5.5 cm in a male for an individual of short stature (eg, one or more standard deviations below mean height*) with shared decision making; OR
        5. Complications (e.g., endoleak) from a previously placed endograft; OR
        6. Individual requires chemotherapy, radiation therapy or solid organ transplant with aneurysm 4 – 5.4 cm diameter and with shared decision-making OR 
        7. Saccular aneurysm

    *Mean height for adult men in the United States is 68.9 inches, and 63.5 inches for women. One or more standard deviations (3 inches) below the mean are less than or equal to 65.9 inches for men and 60.5 inches for women.

    THORACIC AORTIC ANEURYSM (TAA) REPAIR
    Open (Surgical) TAA Repair (33875, 33877)
    1. Open (surgical) thoracic aneurysm repair (OTAR) of a radiographically confirmed TAA may be considered reasonable and necessary when the following requirements are met:
      1. Absence of prohibitive risk for perioperative mortality and morbidity per an evidence-based decision tool (eg, ASC NSQIP Surgical Risk Calculator)
          AND 
      2. Any of the following:
        1. Asymptomatic descending aortic aneurysm and either of the following:
          1. Aneurysm diameter greater than or equal to 5.5 cm; OR
          2. Aneurysm diameter less than 5. 5 cm and either:
            1. Aneurysm growth rate confirmed by imaging (eg, CT, MRI, TTE) greater than or equal to 0.5 cm within 1 year; OR
            2. High risk for aortic rupture; OR
      3. Individual with one or more high-risk factors for aortic rupture:
        1. Female; OR
        2. Genetic aortopathy (eg, Marfan, Loeys-Dietz, or vascular Ehlers Danlos syndrome, heritable thoracic aortic disease); OR
        3. Infectious aortitis with aneurysm; OR
        4. Saccular aneurysm; OR
      4. Individuals with Loeys-Dietz syndrome (LDS) with aneurysm diameter greater than or equal to 4 cm with one or more of the following 
        1. Aneurysm diameter growth rate confirmed by imaging (eg, CT, MRI, TTE) is greater than 0.3 cm within 1 year; OR
        2. First-degree relative with history of aortic dissection; OR
      5. Individuals with Marfan syndrome and descending TAA diameter greater than or equal to 5.0 cm
         

    Thoracic Endovascular Aneurysm Repair of TAA (33880 – 33884, 33886)

    1. TEVAR of a radiographically confirmed TAA may be considered reasonable and necessary when the following requirements are met:
      1. Any of the following:
        1. Asymptomatic descending aortic aneurysm and either of the following:
          1. Aneurysm diameter greater than or equal to 5.5 cm; OR
          2. Aneurysm diameter less than 5.5 cm and either:
            1. Aneurysm growth rate confirmed by imaging (eg, CT, MRI, TTE) greater than or equal to 0.5 cm within 1 year OR
            2. High risk for aortic rupture; OR
        2. Complications (e.g., endoleak) from a previously placed endograft; OR
        3. Individual with one or more high-risk factors for aortic rupture:
          1. Female; OR
          2. Genetic aortopathy (e.g., Marfan, Loeys-Dietz, or vascular Ehlers Danlos syndrome, heritable thoracic aortic disease); OR
          3. Infectious aortitis with aneurysm; OR
        4. Saccular aneurysm
            AND
      2. Absence of the following contraindications
        1. Infection (e.g., local or systemic); AND
        2. Known sensitivity or allergy to device materials (e.g., gold, nitinol, polyester, polypropylene); AND
        3. Prohibitive risk for perioperative mortality and morbidity per an evidence-based decision tool (e.g., ASC NSQIP Surgical Risk Calculator);

    Fenestrated Endovascular Aneurysm Repair of TAA (34841 – 34848)

    1. FEVAR of radiographically confirmed TAA may be considered reasonable and necessary when the following requirements are met:
      1. Aneurysm of the descending thoracic aorta with a need to maintain left subclavian artery flow
        AND 
      2. Any of the following: 
        1. Aneurysm diameter greater than or equal to 5.5 cm; OR
        2. Aneurysm diameter less than 5.5 cm and either: 
          1. Aneurysm growth rate confirmed by imaging (eg, CT, MRI, TTE) greater than or equal to 0.5 cm within 1 year; OR
          2. High risk for aortic rupture OR
        3. Complications (e.g., endoleak) from a previously placed endograft; OR
        4. Individual requires chemotherapy, radiation therapy or solid organ transplant with aneurysm diameter 4 – 5.4 cm and with shared decision-making OR 
        5. Saccular aneurysm AND
      3. Individual is at high risk for debranching subclavian procedures for perioperative mortality and morbidity per evidence-based decision tool (e.g., ASC NSQIP Surgical Risk Calculator); AND
      4. Suitable anatomy for an FDA-approved fenestrated endovascular device; AND
      5. Absence of the following contraindications 
        1. Infection (e.g., local or systemic); AND
        2. Known hypersensitivity to heparin; AND
        3. Known sensitivity or allergy to device materials (e.g., expanded polytetrafluoroethylene (ePTFE), fluorinated ethylene propylene (FEP), gold and/or nitinol (nickel-titanium alloy)
    Medical Policy Number:  M.62
    Medical Policy Name: Keratoplasty 
    Effective Date:  06/01/2026
    Preauthorization Required:  Yes

    Codes:  0402T, 65710, 67530, 65750, 65755, 65756, 65757, 65785
    Policy Statement:

    Corneal Collagen Cross Linking (CXL)

    1. Corneal Collagen Cross Linking (CXL) may be considered reasonable and necessary when the following criteria is met:
      1. Diagnosis of progressive keratoconus and one or more of the following vision changes within the preceding 12 months:
        1. Increase of 1.00 diopter (D) or more in the steepest keratometry measurement; OR
        2. Increase of mean keratometry of 0.7 D or more; OR
        3. Thinning of corneal pachymetry of 10 microns or more; OR
        4. Reduction in uncorrected visual acuity or best spectacle corrected visual acuity by more than one line
          AND
      2. Both of the following:
        1. Clear central cornea (without scarring or disease); AND
        2. Corneal thickness of at least 400 microns at the time of treatment
    Intrastromal Corneal Ring Segments (Intacs)
    1. Intrastromal Corneal Ring Segments (Intacs) may be considered  reasonable and necessary when the following criteria is met:
      1. Diagnosis of keratoconus with progressive deterioration of vision; AND
      2. Inadequate vision correction with eyeglasses or contacts; AND
      3. Corneal transplantation is the ONLY alternative to Intacs for improving vision; AND
      4. 21 years of age or older; AND
      5. Clear central cornea; AND
      6. Corneal thickness of 450 microns or more at the proposed incision site

    Deep Anterior Lamellar Keratoplasty (DALK)

    1. Deep anterior lamellar keratoplasty (DALK) may be considered reasonable and necessary when the following criteria are met:
      1. Disease involving the anterior 95% of corneal thickness with normal endothelium; AND 
      2. Other treatment options (eg, conventional CXL, Intacs) have failed or are not indicated

    Full Thickness Corneal Transplantation (Penetrating Keratoplasty)

    1. Full Thickness Corneal Transplantation (Penetrating Keratoplasty) may be considered reasonable and necessary when the following criteria is met:
      1. Full Thickness Corneal Transplantation (Penetrating Keratoplasty) is indicated for keratoconus when other treatment options (conventional CXL, Intacs, DALK) have failed or are not indicated 
      2. Penetrating keratoplasty is also indicated for corneal degenerations/dystrophies, keratitis, and trauma.
         
    Medical Policy Number:   M.63
    Medical Policy Name: Total Shoulder Arthroplasty
    Effective Date:  06/01/2026
    Preauthorization Required:  Yes

    Codes:  23472 23473 23474
    Policy Statement:  New Criteria

    1. Total shoulder Arthroplasty may be reasonable and necessary when ONE or more of the following criteria are met:
      1. Degenerative glenohumeral joint disease including osteoarthritis (OA), post-traumatic arthritis, rheumatoid arthritis (RA),  osteonecrosis,  arthropathy with rotator cuff deficit when all the following are present: AND
        1. Documented radiographic evidence of the diagnosis (e.g., irregular joint surfaces, subchondral cysts, glenoid flattening or sclerosis, periarticular osteophytes, joint subluxation, joint space narrowing, or avascular necrosis); AND
        2. Documentation of at least 12 weeks of unsuccessful conservative therapy. (If conservative therapy is not appropriate, the medical record must clearly document why such approach is not reasonable). Nonoperative treatment must include a trial of supervised PT and Corticosteroid injections.
      2. Treatment of acute proximal humerus fractures (PHFs) not amenable to conservative therapy or internal fixation.
      3. Treatment of nonunion or malunion PHFs with radiographic evidence.
      4. Reconstruction following tumor resection of the glenohumeral joint, proximal humerus, or adjacent tissue.
      5. Massive irreparable rotator cuff tears (MIRCTs) when ALL  the following are present:
        1. Evidence of massive rotator cuff tear (MRCT) by magnetic resonance imaging (MRI) or arthroscopy (e.g., tear size greater than 5 cm in an anterior-posterior or medial-lateral orientation, OR tears of 2 or more tendons, OR retraction of the tendon to the glenoid rim with greater than 2/3 of the greater tuberosity exposed on imaging in the sagittal plane). AND
        2. Pseudo-paralysis. (MRCT with active elevation less than 90° against gravity) AND
        3. Documentation of at least 12 weeks of unsuccessful conservative therapy including 12 weeks of supervised physical therapy (PT). (If conservative therapy is not appropriate, the medical record must clearly document why such approach is not reasonable).
      6. Reverse total shoulder arthroplasty (RTSA) following failed anatomic total shoulder arthroplasty (aTSA) or failed hemiarthroplasty (HA).
    Medical Policy Number:  M.64
    Medical Policy Name: Power and Manual Wheelchairs and Accessories 
    Effective Date:  06/01/2026
    Preauthorization Required:  Yes

    Codes:   K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, K0009, E1028, E1161, E1226, E2205, E2228, E2230
    Policy Statement:

    Utilizing LCD Manual Wheelchair Bases (L33788)
    https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33788&ver=15

    **No changes are being made to Power Wheelchairs and Accessories, these are currently being reviewed with no changes to criteria.   Only adding review of Manual Wheelchairs and Accessories

    Revised Medical Policies

    Medical Policy Number: M.14
    Medical Policy Name: Amniotic Membrane and Amniotic Fluid
    Effective Date: 06/01/2026
    Adding criteria to diabetic foot ulcer:  
    Adequate circulation/oxygenation to support tissue growth/wound healing as evidenced by physical examination (e.g., Ankle-Brachial Index [ABI] of no less than 0.60, toe pressure greater than 30 millimeters of mercury [mmHg]).
    Medical Policy Number: M.3
    Medical Policy Name: Bioengineered Skin and Soft Tissue Substitutes
    Effective Date: 06/01/2026
    Adding criteria to diabetic foot ulcer:  
    Adequate circulation/oxygenation to support tissue growth/wound healing as evidenced by physical examination (e.g., Ankle-Brachial Index [ABI] of no less than 0.60, toe pressure greater than 30 millimeters of mercury [mmHg]).
    Medical Policy Number:  M.30
    Medical Policy Name: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker and Defibrillators
    Effective Date:  06/01/2026
    Codes:    0695T 0696T 0795T 0796T 0797T 0798T 0799T 0800T 0801T 0802T 0803T 0804T 0823T 0824T 0825T 0826T 33206 33208 33210 33211 33212 33213 33214 33215 33216 33217 33221 33224 33225 33226 33227 33228 33229 33233 33234 33235 33274 33275 93279 93280 93281 93286 93288 93294 93296 C1605 C1779 C1785 C1786 C1898 C2619 C2620 C2621 C7537 C7538 C7539 C7540
    Preauthorization Required:  Yes

    Utilizing Milliman Criteria Guidelines (MCG) for Cardiac Pacemakers

    **No changes are being made to the defibrillator criteria

     

    Medical Policy Number:  M.31
    Medical Policy Name: Electrophysiology Testing 
    Effective Date:  06/01/2026
    Preauthorization Required:  Yes
    Codes: 93600, 93602, 93603, 93609, 93610, 93612, 93613, 93618, 93619, 93620, 93624, 
    Policy Statement:

    Utilizing 
    National Coverage Determination (NCD) 20.12 - Diagnostic Endocardial Electrical Stimulation (Pacing) 
    NCD - Diagnostic Endocardial Electrical Stimulation (Pacing) (20.12)

    Utilizing National Coverage Determination (NCD) 20.13 - HIS Bundle Study
    NCD - HIS Bundle Study (20.13)
     
    Medical Policy Number:  M.31
    Medical Policy Name: Cardiac Ablation 
    Effective Date:  06/01/2026
    Preauthorization Required:  Yes
    Codes:     93650, 93653, 93654, 93656
    Policy Statement:
    Utilizing Milliman Criteria Guidelines (MCG)

     

    Medical Policy Number:   
    Medical Policy Name: Cosmetic and Reconstructive Surgery
    Effective Date:  06/01/2026
    Preauthorization Required:  Yes
    Codes:   21280, 21282, 67900, 67912, 67911, 67950, 67961, 67966
    Policy Statement:

    Adding
    1. Internal Browpexy (67900) is considered cosmetic and not reasonable and necessary for all indications/conditions.
    1. Eyelid surgery for correction of Lagophthalmos (67912) may be considered reconstructive, reasonable and necessary when the upper eyelid does not provide complete closure to the eye, resulting in dryness and other complications.
    1. Lid retraction Surgery (67911) is considered reconstructive and reasonable and necessary when all the following criteria are met:
      1. Other causes have been eliminated as the reason for the lid retraction such as use of dilating eye drops, glaucoma medications; AND
      2. There is a functional impairment (e.g., dry eyes, pain/discomfort, tearing, blurred vision); AND
      3. Tried and failed conservative treatments; AND
      4. In cases of thyroid eye disease, two or more Hertel measurements at least 6 months apart with the same base measurements are unchanged
    1. Canthoplasty/Canthopexy  (21280, 21282, 67950)  may be considered reconstructive and reasonable and necessary when all the following criteria are met:
      1. There is a functional impairment; AND
      2. Repair of ectropion or entropion will not correct condition; AND
      3. At least one of the following is present:
        1. Epiphora (excess tearing) not resolved by conservative measures; OR
        2. Corneal dryness unresponsive to lubricants; OR
        3. Corneal ulcer
    1. Repair of Floppy Eyelid Syndrome (FES)(67961, 67966) may be considered reconstructive and reasonable and necessary when all the following criteria are met:
      1. Subjective symptoms must include eyelids spontaneously "flipping over" when the member sleeps due to rubbing on the pillow, and one of the following
        1. Eye pain or discomfort; OR
        2. Excess tearing; OR
        3. Eye irritation, ocular redness, and discharge
      2. Physical examination that documents all of the following
        1. Both the following
          1. Eyelash ptosis; AND
          2. Significant upper eyelid laxity
          AND
        2. One of the following
          1. Presence of giant papillary conjunctivitis (GPC); OR
          2. Corneal findings such as one of the following:
            1. Superficial punctate erosions (SPK); OR
            2. Corneal abrasion (documentation of a history of corneal abrasion or recurrent erosion syndrome is considered sufficient); OR
            3. Microbial keratitis
      3. Clear, high-quality, clinical photographs that clearly document Floppy Eyelid Syndrome and demonstrate both of the following
        1. Lids must be everted in the photographs; AND
        2. Conjunctival surface (underbelly) of the lids must be clearly visible
      4. Documentation that conservative treatment has been tried and failed; examples may include
        1. Ocular lubricants both drops (daytime) and ointments (bedtime)
        2. Short trial of antihistamines
        3. Topical steroid drops
        4. Eye shield and/or taping the lids at bedtime
      5. Infections of the eye have been ruled out; examples may include:
        1. Allergic conjunctivitis
        2. Atopic keratoconjunctivitis
        3. Blepharitis
        4. Contact lens (CL) complication [e.g., giant papillary conjunctivitis (GPC)]
        5. Superior limbic keratoconjunctivitis (SLK)
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