H02.516
BillableAbnormal innervation syndrome left eye, unspecified eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.516 an HCC code?
No. H02.516 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
H02.516 is the ICD-10-CM diagnosis code for abnormal innervation syndrome left eye, unspecified eyelid. A condition affecting the left eye where the nerves controlling eyelid movement are not functioning properly, but the specific eyelid (upper or lower) is not specified. H02.516 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).
H02.516 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 is a less specific code; attempt to determine which eyelid is affected before using it.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.516 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a less specific code; attempt to determine which eyelid is affected before using it
- •Document the reason for unspecified eyelid location if clarification is not available