Question 1

What is ICD-10 code H02.215?

Accepted Answer

H02.215 is the ICD-10-CM diagnosis code for cicatricial lagophthalmos left lower eyelid. Scarring of the left lower eyelid causing inability to close the eye completely. H02.215 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).

H02.215 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 the documentation specifies left eye and lower eyelid location.

Question 2

Is H02.215 an HCC code?

Accepted Answer

No. H02.215 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H02.215 billable?

Accepted Answer

Yes. H02.215 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H02.215 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for H02.215?

Accepted Answer

H02.215 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards H02.215 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H02.215?

Accepted Answer

Verify the documentation specifies left eye and lower eyelid location If both eyelids are affected, use code H02.21B instead

HCC Buddy Code Card

H02.215

Is H02.215 an HCC code?

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Open H02.215 in the Interactive Encoder

H02.215 ICD-10-CM Code: Cicatricial lagophthalmos left lower eyelid

HCC Buddy Code Card

H02.215

Is H02.215 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H02.215 in the Interactive Encoder