H05.412
BillableEnophthalmos due to atrophy of orbital tissue, left eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H05.412 an HCC code?
No. H05.412 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
H05.412 is the ICD-10-CM diagnosis code for enophthalmos due to atrophy of orbital tissue, left eye. The left eye appears sunken due to loss of fatty tissue and muscle in the eye socket. H05.412 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).
H05.412 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.
This code is more specific than H05.402 because it identifies atrophy as the cause.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H05.412 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is more specific than H05.402 because it identifies atrophy as the cause
- •Ensure documentation clearly states the atrophy is the cause of the enophthalmos