Is H02.403 a billable ICD-10-CM code?

Yes. H02.403 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H02.403 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of eyelid, lacrimal system and orbit (H00-H05).

What cannot be coded together with H02.403?

H02.403 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H02.403 (H02) and apply to it just the same.

H02.403

H02.403 — Unspecified ptosis of bilateral eyelids

Billable / specific codeICD-10-CMbilateral

H02.403 is a billable, specific ICD-10-CM code for unspecified ptosis of bilateral eyelids. It is valid for submission on a claim.

Excludes1 inherited from the categories above H02.403

These are not written on H02.403, but they bind it: a note on a category applies to every code beneath it. Billing H02.403 with anything listed here is a denial.

Written on H02 — Other disorders of eyelid

congenital malformations of eyelid (Q10.0-Q10.3)

Risk adjustment

H02.403 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

H02.403 is named in 15 Medicare coverage policies — 15 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A54095Billing and Coding: Nerve Conduction Studies and Electromyography
A54969Billing and Coding: Nerve Conduction Studies and Electromyography
A56439Billing and Coding: Blepharoplasty
A56503Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift

Code history

H02.403 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share H02.40. If H02.403 is not quite right, the correct code is usually one of these.

Questions about H02.403

Is H02.403 a billable ICD-10-CM code?: Yes. H02.403 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H02.403 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of eyelid, lacrimal system and orbit (H00-H05).
What cannot be coded together with H02.403?: H02.403 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H02.403 (H02) and apply to it just the same.