H05.413 ICD-10-CM Code: Enophthalmos due to atrophy of orbital tissue, bilateral
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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)
H05.413
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceEnophthalmos due to atrophy of orbital tissue, bilateral
This condition occurs when both eyes sink backward into their sockets due to shrinkage or wasting away of the fatty tissue and muscles that normally fill the eye socket. This causes the eyes to appear sunken or recessed in the face.
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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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H05.413 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H05.413 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H05.413 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H05.413 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H05.413 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H05.413 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H05.413 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 H05.413 an HCC code?
No. H05.413 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
H05.413 is the ICD-10-CM diagnosis code for enophthalmos due to atrophy of orbital tissue, bilateral. This condition occurs when both eyes sink backward into their sockets due to shrinkage or wasting away of the fatty tissue and muscles that normally fill the eye socket. This causes the eyes to appear sunken or recessed in the face. H05.413 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).
H05.413 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.
Verify that the condition is documented as bilateral (affecting both eyes) before assigning this code; if only one eye is affected, use H05.411 (right eye) or H05.412 (left eye) instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H05.413 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the condition is documented as bilateral (affecting both eyes) before assigning this code; if only one eye is affected, use H05.411 (right eye) or H05.412 (left eye) instead
- •Ensure the underlying cause of orbital tissue atrophy is documented and coded separately if identifiable (such as trauma, radiation, or systemic disease)