Question 1

What is ICD-10 code H02.826?

Accepted Answer

H02.826 is the ICD-10-CM diagnosis code for cysts of left eye, unspecified eyelid. Small fluid-filled sacs or bumps on the left eye when the specific upper or lower eyelid location is not documented. H02.826 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).

H02.826 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 the specific eyelid (upper or lower) cannot be determined from documentation.

Question 2

Is H02.826 an HCC code?

Accepted Answer

No. H02.826 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H02.826 billable?

Accepted Answer

Yes. H02.826 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H02.826 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for H02.826?

Accepted Answer

H02.826 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards H02.826 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H02.826?

Accepted Answer

Use this code only when the specific eyelid (upper or lower) cannot be determined from documentation Query provider for clarification on eyelid location if possible

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H02.826

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H02.826 ICD-10-CM Code: Cysts of left eye, unspecified eyelid

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H02.826

Is H02.826 an HCC code?

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