H05.419
BillableEnophthalmos due to atrophy of orbital tissue, unspecified eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H05.419 an HCC code?
No. H05.419 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
H05.419 is the ICD-10-CM diagnosis code for enophthalmos due to atrophy of orbital tissue, unspecified eye. An eye appears sunken due to loss of fatty tissue and muscle in the eye socket when the specific eye is not documented. H05.419 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).
H05.419 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.
Query the provider for laterality information to assign a more specific code (H05.411 or H05.412).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H05.419 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.