Is H05.401 a billable ICD-10-CM code?

Yes. H05.401 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H05.401 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 H05.401?

H05.401 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 H05.401 (H05) and apply to it just the same.

H05.401

H05.401 — Unspecified enophthalmos, right eye

Billable / specific codeICD-10-CMright

H05.401 is a billable, specific ICD-10-CM code for unspecified enophthalmos, right eye. It is valid for submission on a claim.

Excludes1 inherited from the categories above H05.401

These are not written on H05.401, but they bind it: a note on a category applies to every code beneath it. Billing H05.401 with anything listed here is a denial.

Written on H05 — Disorders of orbit

congenital malformation of orbit (Q10.7)

Risk adjustment

H05.401 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

H05.401 is named in 11 Medicare coverage policies — 11 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
A56551Billing and Coding: Visual Fields Testing

Code history

H05.401 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 H05.40. If H05.401 is not quite right, the correct code is usually one of these.

Questions about H05.401

Is H05.401 a billable ICD-10-CM code?: Yes. H05.401 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H05.401 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 H05.401?: H05.401 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 H05.401 (H05) and apply to it just the same.