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.

Check H21.43 with the rest of the claim: free scrubber

Excludes1 inherited from the categories above H21.43

A category’s note binds every code beneath it.

Written on H21.4: Pupillary membranes

congenital pupillary membranes (Q13.8)

Excludes2 inherited from the categories above H21.43

Not part of this code, but both may be coded when both are present.

Written on H21: Other disorders of iris and ciliary body

sympathetic uveitis (H44.1-)

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

H21.43 is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

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)

Code history

Unchanged in every release from FY2024 to FY2027.