H02.219 Billable Code FY2027 Status: Active

H02.219: Cicatricial lagophthalmos unsp eye, unspecified eyelid

Cicatricial lagophthalmos unspecified eye, unspecified eyelid

Effective Date: 2026-10-01
Dataset: ICD-10-CM FY2027
Source: Centers for Disease Control and Prevention (CDC)
Last Verified: 2026-10-01
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Quick Clinical & Billing Summary

What is ICD-10-CM code H02.219? H02.219 represents Cicatricial lagophthalmos unsp eye, unspecified eyelid. Under official CDC guidelines, this code is billable and specific for claim submission.

Current release: FY2027 (Effective October 1, 2026). Sourced directly from CDC NCHS files.

Code Hierarchy & Classification

⌊ Category H02: Other disorders of eyelid
⌊ H02.219: Cicatricial lagophthalmos unsp eye, unspecified eyelid (Current Code)

Clinical Guidance & Documentation Standards

Clinical documentation should substantiate the medical necessity of this diagnosis, including laterality, anatomical site specificity, and clinical severity.

Associated Procedures & Medicare RVU Reimbursement

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Typical outpatient and office evaluation procedures frequently billed alongside diagnosis H02.219:

CPT/HCPCS Description Work RVU Non-Facility Fee Facility Fee
99213 Office/outpatient visit, established patient, 20-29 minutes (Low MDM) 1.30 $91.69 $66.79
99214 Office/outpatient visit, established patient, 30-39 minutes (Moderate MDM) 1.92 $133.61 $100.21
96372 Therapeutic, prophylactic, or diagnostic injection (subcutaneous/intramuscular) 0.17 $18.34 $12.44
Based on official CMS 2026 Physician Fee Schedule conversion factor ($32.7476). Payments vary by locality GPCI.

CPT Modifier & Billing Rules

Modifier 25 Significant E/M

Append when a significant, separately identifiable evaluation and management service is provided on the same calendar day as a minor surgical procedure or injection.

Modifier 59 Distinct Service

Identifies procedures or services not normally reported together but distinct under the clinical circumstances. Use CMS X-modifiers (XE, XS, XP, XU) where required by Medicare.

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Frequently Asked Questions about H02.219

Is H02.219 a billable ICD-10 code?

Yes, H02.219 is a valid, billable and specific ICD-10-CM code. It can be reported as a primary or secondary diagnosis on medical claims.

What is the ICD-10 code for Cicatricial lagophthalmos unsp eye, unspecified eyelid?

The primary ICD-10-CM code for Cicatricial lagophthalmos unsp eye, unspecified eyelid is H02.219.

What is the effective date of the current H02.219 code?

The code is active for fiscal year FY2027, effective starting 2026-10-01.

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Official Provenance: Sourced from CDC / NCHS FY2027 ICD-10-CM files. Report a Data Error
Verified: 2026-10-01