H02.201
BillableUnspecified lagophthalmos right upper eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.201 an HCC code?
No. H02.201 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
H02.201 is the ICD-10-CM diagnosis code for unspecified lagophthalmos right upper eyelid. Inability of the right upper eyelid to close completely, often resulting in dry eye and potential corneal damage. H02.201 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).
H02.201 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.
Lagophthalmos means incomplete eyelid closure; ensure documentation specifies which eyelid(s) are affected.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.201 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Lagophthalmos means incomplete eyelid closure; ensure documentation specifies which eyelid(s) are affected
- •If the cause is known (such as thyroid eye disease or facial nerve palsy), consider coding the underlying condition as well