H02.36
BillableBlepharochalasis left eye, unspecified eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.36 an HCC code?
No. H02.36 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
H02.36 is the ICD-10-CM diagnosis code for blepharochalasis left eye, unspecified eyelid. Excessive sagging or looseness of the skin on the left eyelid when the specific eyelid (upper or lower) is not documented. H02.36 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).
H02.36 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.
Use this code only when documentation indicates left eye involvement but does not specify whether upper or lower eyelid is affected.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.36 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when documentation indicates left eye involvement but does not specify whether upper or lower eyelid is affected
- •Query the provider if eyelid location can be determined to allow for more specific coding