H02.103
BillableUnspecified ectropion of right eye, unspecified eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.103 an HCC code?
No. H02.103 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
H02.103 is the ICD-10-CM diagnosis code for unspecified ectropion of right eye, unspecified eyelid. Ectropion is a condition where the eyelid turns outward, away from the eye surface, causing the inner eyelid tissue to be exposed. This code indicates the condition affects the right eye but the specific eyelid (upper or lower) has not been identified. H02.103 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).
H02.103 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.
Query the provider if the specific eyelid (upper H02.101 or lower H02.102) can be determined, as this provides more precise documentation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.103 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Query the provider if the specific eyelid (upper H02.101 or lower H02.102) can be determined, as this provides more precise documentation
- •Ectropion codes require laterality (right/left) and eyelid specification; if documentation is truly unspecified, H02.103 is appropriate, but attempt clarification first