H02.534
BillableEyelid retraction left upper eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H02.534 an HCC code?
No. H02.534 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
H02.534 is the ICD-10-CM diagnosis code for eyelid retraction left upper eyelid. The upper eyelid on the left eye is pulled back or retracted, exposing more of the eye surface than normal. H02.534 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).
H02.534 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.
Confirm documentation specifies left eye and upper eyelid to distinguish from other eyelid retraction codes.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.534 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm documentation specifies left eye and upper eyelid to distinguish from other eyelid retraction codes
- •Consider if this is secondary to another condition like Graves' disease or facial nerve palsy