What I meant by primary and secondary is that they are described a little differently. 15820 doesn't mention whether the fat pad is "extensive", and 15822 doesn't indicate if the skin is weighting the lid down to the extent of being "extensive". Because of that, am I wrong to assume that they aren't "extensive", so they are probably not, in most cases, affecting the field of vision? The reason I'm asking may help.. I work for an insurance company. Currently we don't require PreAuth (PA) on any of the 4 codes, we just pay them at a 50% benefit and don't look at any of them because the administration cost outweighs the cost to the plan. I'd like to propose to my company that we pay 15821 and 15823 under regular medical benefits (80% after ded, etc., whatever the group/employer has chosen for their outpatient surgery benefit coverage), without PA, but keep paying the 15820 and 15822 at 50% with no PA and the provider or member can appeal for the higher benefit if they can show the visual field was affected, even though the skin or fat pad wasn't "extensive". Does that help? I'm just looking for an opinion on my logic here. If I'm totally off then that's cool, let me know. Thank you!What do you mean by 'primary' and 'secondary' codes? Either way, whether a service is cosmetic or medically necessary is something that is determined based on physician assessment of patient needs and/or by payer policies - CPT codes are never cosmetic or not in and of themselves. In this case, whether or not the field of vision is affected is usually one of the main criteria that payers use to determine whether or not to allow coverage for the procedure, but the code will be selected on what actual procedure is performed.