H02.21C
BillableCicatricial lagophthalmos, bilateral, upper and lower eyelids
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.21C an HCC code?
No. H02.21C 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
H02.21C is the ICD-10-CM diagnosis code for cicatricial lagophthalmos, bilateral, upper and lower eyelids. Scarring of the eyelids on both eyes that prevents the eyelids from closing completely, affecting both upper and lower lids. H02.21C 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).
H02.21C 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 indicates bilateral involvement with both upper and lower eyelids affected; do not use if only one eye or one eyelid is involved.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.21C sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates bilateral involvement with both upper and lower eyelids affected; do not use if only one eye or one eyelid is involved
- •Cicatricial lagophthalmos results from scarring conditions such as Stevens-Johnson syndrome, ocular cicatricial pemphigoid, or chemical burns