H02.521
BillableBlepharophimosis right upper eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.521 an HCC code?
No. H02.521 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
H02.521 is the ICD-10-CM diagnosis code for blepharophimosis right upper eyelid. A condition of the right upper eyelid characterized by abnormal narrowing or shortening of the eyelid opening, often present from birth or early childhood. H02.521 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).
H02.521 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.
Blepharophimosis is often congenital; verify if this is a developmental condition or acquired.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.521 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Blepharophimosis is often congenital; verify if this is a developmental condition or acquired
- •Confirm right eye and upper eyelid location in the documentation