H02.212
BillableCicatricial lagophthalmos right lower eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.212 an HCC code?
No. H02.212 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
H02.212 is the ICD-10-CM diagnosis code for cicatricial lagophthalmos right lower eyelid. Scarring of the right lower eyelid causing inability to close the eye completely. H02.212 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).
H02.212 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 is specific to the lower eyelid; verify correct eyelid location in documentation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.212 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is specific to the lower eyelid; verify correct eyelid location in documentation
- •Consider documenting the underlying cause of scarring (trauma, surgery, burn, etc.) for complete clinical picture