H02.001
BillableUnspecified entropion of right upper eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.001 an HCC code?
No. H02.001 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H02.001 is the ICD-10-CM diagnosis code for unspecified entropion of right upper eyelid. The upper eyelid of the right eye is turning inward toward the eye surface, but the specific cause or type is not documented. This can cause irritation and discomfort. H02.001 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).
H02.001 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.
Entropion codes require specification of laterality and eyelid location; this code specifies right upper.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.001 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Entropion codes require specification of laterality and eyelid location; this code specifies right upper
- •Review documentation to determine if a more specific entropion type code (mechanical, spastic, etc.) should be used instead