Question 1

What is ICD-10 code H01.013?

Accepted Answer

H01.013 is the ICD-10-CM diagnosis code for ulcerative blepharitis right eye, unspecified eyelid. Inflammation of the right eye with ulceration on the eyelid margin, but the specific eyelid location is not specified. H01.013 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of eyelid, lacrimal system and orbit (h00-h05).

H01.013 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Use when ulcerative blepharitis of the right eye is documented but upper versus lower eyelid is unclear.

Question 2

Is H01.013 an HCC code?

Accepted Answer

No. H01.013 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H01.013 billable?

Accepted Answer

Yes. H01.013 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H01.013 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

Which HCC does H01.013 map to under V28?

Accepted Answer

H01.013 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does H01.013 pay in RAF?

Accepted Answer

H01.013 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for H01.013?

Accepted Answer

H01.013 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards H01.013 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports H01.013?

Accepted Answer

Use when ulcerative blepharitis of the right eye is documented but upper versus lower eyelid is unclear If both eyelids are affected, use H01.01A instead H01.013 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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H01.013

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H01.013 ICD-10-CM Code: Ulcerative blepharitis right eye, unspecified eyelid

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H01.013

Is H01.013 an HCC code?

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