H02.213
BillableCicatricial lagophthalmos right eye, unspecified eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.213 an HCC code?
No. H02.213 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
H02.213 is the ICD-10-CM diagnosis code for cicatricial lagophthalmos right eye, unspecified eyelid. This condition occurs when scar tissue on the eyelid prevents the eye from closing completely, affecting the right eye. This can lead to dryness and irritation of the eye surface because it remains partially exposed. H02.213 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).
H02.213 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 laterality is documented as right eye (unilateral) versus bilateral before assigning this code; if both eyes are affected, assign the appropriate bilateral code instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.213 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify laterality is documented as right eye (unilateral) versus bilateral before assigning this code; if both eyes are affected, assign the appropriate bilateral code instead
- •Ensure the medical record specifies that the lagophthalmos is cicatricial (scar-related) in nature, as this distinguishes it from other causes of incomplete eyelid closure