What is ICD-10 code H01.125?

H01.125 is the ICD-10-CM diagnosis code for Discoid lupus erythematosus of left lower eyelid. A chronic autoimmune skin condition affecting the lower eyelid of the left eye, causing inflammation and potential scarring from discoid lupus erythematosus. H01.125 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H01.125 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. H01.125 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. H01.125 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.

What is the V28 vs V24 difference for H01.125?

H01.125 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 H01.125 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. It does, however, map under the Part D RxHCC model (Lupus, Cutaneous), which affects the ESRD and/or Part D (RxHCC) risk scores. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

What should coders know when reporting H01.125?

Confirm the specific location is the lower eyelid of the left eye to differentiate from upper eyelid codes Document whether the condition is active or in remission, as this may affect treatment decisions

2026 ICD-10-CM H01.125: Discoid lupus erythematosus of left

ICD-10-CM Code View

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Code lookupH01.125Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of eyelid, lacrimal system and orbit (H00-H05)

H01.125

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Discoid lupus erythematosus of left lower eyelid

A chronic autoimmune skin condition affecting the lower eyelid of the left eye, causing inflammation and potential scarring from discoid lupus erythematosus.

Buddy Insight

Discoid lupus erythematosus of the left lower eyelid involves autoimmune discoid lesions on the left lower eyelid, which can cause scarring, cicatricial changes, and functional impairment of the lower eyelid's role in tear drainage and ocular surface protection.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 317

Lupus, Cutaneous

RAF 0.113

Code Book Path

Official

H01.1Noninfectious dermatoses of eyelid

H01.12Discoid lupus erythematosus of eyelid

H01.125Discoid lupus erythematosus of left lower eyelid

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H01.125 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H01.125 in this effective period.

Related Child Codes

Official

H01.121Discoid lupus erythematosus of right upper eyelid

H01.122Discoid lupus erythematosus of right lower eyelid

H01.123Discoid lupus erythematosus of right eye, unspecified eyelid

H01.124Discoid lupus erythematosus of left upper eyelid

H01.126Discoid lupus erythematosus of left eye, unspecified eyelid

Includes

Official

ICD-10-CM does not list Includes notes for H01.125 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H01.125 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H01.125 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H01.125 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H01.125 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Examination findings documenting discoid lupus lesions on the left lower eyelid

Diagnostic confirmation of discoid lupus (clinical or histopathological)

Assessment of lower eyelid position and function including tear drainage

Evaluation for cicatricial changes or ectropion

MEAT Support

HCC Buddy guidance

Examination findings documenting discoid lupus lesions on the left lower eyelid

Diagnostic confirmation of discoid lupus (clinical or histopathological)

Assessment of lower eyelid position and function including tear drainage

Evaluation for cicatricial changes or ectropion

Audit Caution

HCC Buddy guidance

Incorrectly lateralizing to the right side when the left lower eyelid is affected

Using upper eyelid codes when the lower eyelid is the site of involvement

Not coding each affected eyelid separately when multiple eyelids are involved

Using nonspecific blepharitis or dermatitis codes when discoid lupus has been diagnosed

Common Mistakes

HCC Buddy guidance

H01.122 — Discoid lupus erythematosus of right lower eyelid: contralateral side

H01.124 — Discoid lupus erythematosus of left upper eyelid: same side, different eyelid

H01.126 — Discoid lupus erythematosus of left eye, unspecified eyelid: less specific

L93.0 — Discoid lupus erythematosus: general cutaneous form, not eyelid-specific

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is H01.125 an HCC code?

H01.125 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Lupus, Cutaneous under the Part D RxHCC model.

Code: H01.125
Description: Discoid lupus erythematosus of left lower eyelid
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

RxHCCHCC 317, Lupus, Cutaneous

0.113

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work H01.125 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for H01.125

For H01.125 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed H01.125 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

H01.125 is the ICD-10-CM diagnosis code for discoid lupus erythematosus of left lower eyelid. A chronic autoimmune skin condition affecting the lower eyelid of the left eye, causing inflammation and potential scarring from discoid lupus erythematosus. H01.125 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).

H01.125 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.

This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing H01.125 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H01.125 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Confirm the specific location is the lower eyelid of the left eye to differentiate from upper eyelid codes
•Document whether the condition is active or in remission, as this may affect treatment decisions

Clinical Significance

Documentation Requirements

✓Examination findings documenting discoid lupus lesions on the left lower eyelid
✓Diagnostic confirmation of discoid lupus (clinical or histopathological)
✓Assessment of lower eyelid position and function including tear drainage
✓Evaluation for cicatricial changes or ectropion
✓Management plan and follow-up interval

Commonly Confused Codes

•H01.122: Discoid lupus erythematosus of right lower eyelid: contralateral side
•H01.124: Discoid lupus erythematosus of left upper eyelid: same side, different eyelid
•H01.126: Discoid lupus erythematosus of left eye, unspecified eyelid: less specific
•L93.0: Discoid lupus erythematosus: general cutaneous form, not eyelid-specific