H21.43
H21.43 — Pupillary membranes, bilateral
Billable / specific codeICD-10-CMbilateral
H21.43 is a billable, specific ICD-10-CM code for pupillary membranes, bilateral. It is valid for submission on a claim.
Risk adjustment
H21.43 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
H21.43 is named in 10 Medicare coverage policies — 10 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)
- A56692Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Related codes at this level
Codes that share H21.4. If H21.43 is not quite right, the correct code is usually one of these.
Questions about H21.43
- Is H21.43 a billable ICD-10-CM code?
- Yes. H21.43 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does H21.43 sit in the tabular list?
- Diseases of the eye and adnexa (H00-H59), in the block Disorders of sclera, cornea, iris and ciliary body (H15-H22).