H02.126
BillableMechanical ectropion of left eye, unspecified eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.126 an HCC code?
No. H02.126 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
H02.126 is the ICD-10-CM diagnosis code for mechanical ectropion of left eye, unspecified eyelid. The lower or upper eyelid of the left eye is turning outward away from the eye surface, causing the inner eyelid surface to be exposed. This condition is caused by mechanical factors such as scarring, injury, or loss of skin elasticity rather than muscle weakness. H02.126 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).
H02.126 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.
Verify whether the ectropion affects the upper eyelid (H02.121), lower eyelid (H02.122), or is unspecified (H02.126) before assigning the code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.126 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify whether the ectropion affects the upper eyelid (H02.121), lower eyelid (H02.122), or is unspecified (H02.126) before assigning the code
- •Document the underlying cause if known (such as post-surgical scarring, trauma, or dermatitis) as this may support medical necessity for treatment and help guide clinical management