H05.249 ICD-10-CM Code: Constant exophthalmos, unspecified eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of eyelid, lacrimal system and orbit (H00-H05)
H05.249
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceConstant exophthalmos, unspecified eye
The eye is permanently pushed forward out of its socket due to an underlying condition, but the specific cause or which eye is affected is not documented. This constant bulging of the eye can affect vision and eye comfort.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H05.249 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H05.249 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H05.249 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H05.249 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H05.249 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H05.249 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H05.249 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H05.249 an HCC code?
No. H05.249 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
H05.249 is the ICD-10-CM diagnosis code for constant exophthalmos, unspecified eye. The eye is permanently pushed forward out of its socket due to an underlying condition, but the specific cause or which eye is affected is not documented. This constant bulging of the eye can affect vision and eye comfort. H05.249 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).
H05.249 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 provider documents exophthalmos as constant/persistent but does not specify the underlying cause (such as thyroid disease, tumor, or inflammation) or does not specify laterality (right, left, or bilateral).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H05.249 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the provider documents exophthalmos as constant/persistent but does not specify the underlying cause (such as thyroid disease, tumor, or inflammation) or does not specify laterality (right, left, or bilateral)
- •If the cause is known (e.g., thyroid-related exophthalmos), code the underlying condition first and use a more specific H05.24- code with laterality; query the provider if the eye affected is not documented