Question 1

What is ICD-10 code H04.123?

Accepted Answer

H04.123 is the ICD-10-CM diagnosis code for dry eye syndrome of bilateral lacrimal glands. A condition where both tear glands do not produce adequate tears, resulting in dry eye symptoms affecting both eyes. H04.123 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).

H04.123 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Bilateral dry eye syndrome indicates both glands are involved in tear deficiency.

Question 2

Is H04.123 an HCC code?

Accepted Answer

H04.123 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 3

Is H04.123 billable?

Accepted Answer

Yes. H04.123 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. H04.123 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

Which HCC does H04.123 map to under V28?

Accepted Answer

H04.123 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 5

What RAF reference is published for H04.123?

Accepted Answer

H04.123 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

Question 6

What is the V28 vs V24 difference for H04.123?

Accepted Answer

H04.123 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

Question 7

What documentation supports H04.123?

Accepted Answer

Bilateral dry eye syndrome indicates both glands are involved in tear deficiency Document whether this is primary lacrimal insufficiency or secondary to another condition H04.123 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

Question 8

Can H04.123 be a primary diagnosis?

Accepted Answer

Yes. H04.123 carries no code-first instruction in the FY2026 tabular, so it can be the first-listed diagnosis when it is the condition chiefly responsible for the encounter and the note supports it, and it can also be reported as a secondary diagnosis. For risk adjustment the order does not matter; the V28 category is the same either way.

Question 9

Which codes cannot be reported with H04.123?

Accepted Answer

The Excludes1 note that applies to H04.123 lists congenital malformations of lacrimal system (Q10.4-Q10.6). An Excludes1 condition is not reported together with H04.123; report one or the other, unless the two conditions are unrelated, which the ICD-10-CM Official Guidelines (Section I.A.12.a) allow. The Excludes2 note lists certain conditions originating in the perinatal period (P04-P96); certain infectious and parasitic diseases (A00-B99); complications of pregnancy, childbirth and the puerperium (O00-O9A); congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99); and 9 more (see the notes on this page); those are separate conditions that may be reported together with H04.123 when both are documented.

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H04.123

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H04.123 ICD-10-CM Code: Dry eye syndrome of bilateral lacrimal glands

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H04.123

Is H04.123 an HCC code?

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What This Code Means

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