H02.533
BillableEyelid retraction right eye, unspecified eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.533 an HCC code?
No. H02.533 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
H02.533 is the ICD-10-CM diagnosis code for eyelid retraction right eye, unspecified eyelid. The upper or lower eyelid on the right eye is pulled back or drawn upward more than normal, causing the eye to appear wider open than usual. This condition can occur due to various causes such as thyroid disease, nerve problems, or muscle issues. H02.533 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).
H02.533 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 whether the retraction affects the upper eyelid (H02.531) or lower eyelid (H02.532) before defaulting to 'unspecified' code H02.533, as more specific codes are preferred.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.533 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify whether the retraction affects the upper eyelid (H02.531) or lower eyelid (H02.532) before defaulting to 'unspecified' code H02.533, as more specific codes are preferred
- •Look for documentation of the underlying cause (such as thyroid eye disease, Graves' disease, or facial nerve palsy) as this may require an additional diagnosis code