Question 1

What is ICD-10 code H01.115?

Accepted Answer

H01.115 is the ICD-10-CM diagnosis code for allergic dermatitis of left lower eyelid. An allergic skin reaction affecting the lower eyelid of the left eye, causing inflammation and irritation. H01.115 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).

H01.115 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.

Confirm left eye and lower eyelid location in clinical documentation.

Question 2

Is H01.115 an HCC code?

Accepted Answer

No. H01.115 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 H01.115 billable?

Accepted Answer

Yes. H01.115 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. H01.115 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

What is the V28 vs V24 difference for H01.115?

Accepted Answer

H01.115 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 model rewards H01.115 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H01.115?

Accepted Answer

Confirm left eye and lower eyelid location in clinical documentation Verify allergic cause to differentiate from infectious or irritant dermatitis

HCC Buddy Code Card

H01.115

Is H01.115 an HCC code?

What This Code Means

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Child Codes

Code Hierarchy

Open H01.115 in the Interactive Encoder

H01.115 ICD-10-CM Code: Allergic dermatitis of left lower eyelid

HCC Buddy Code Card

H01.115

Is H01.115 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H01.115 in the Interactive Encoder