Is H43.01 a billable ICD-10-CM code?

Yes. H43.01 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H43.01 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of vitreous body and globe (H43-H44).

What cannot be coded together with H43.01?

H43.01 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 H43.01 (H43.0) and apply to it just the same.

H43.01

H43.01 — Vitreous prolapse, right eye

Billable / specific codeICD-10-CMright

H43.01 is a billable, specific ICD-10-CM code for vitreous prolapse, right eye. It is valid for submission on a claim.

Excludes1 inherited from the categories above H43.01

These are not written on H43.01, but they bind it: a note on a category applies to every code beneath it. Billing H43.01 with anything listed here is a denial.

Written on H43.0 — Vitreous prolapse

vitreous syndrome following cataract surgery (H59.0-)
traumatic vitreous prolapse (S05.2-)

Risk adjustment

H43.01 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

H43.01 is named in 6 Medicare coverage policies — 6 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)
A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
A57071Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

Code history

H43.01 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 H43.0. If H43.01 is not quite right, the correct code is usually one of these.

Questions about H43.01

Is H43.01 a billable ICD-10-CM code?: Yes. H43.01 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H43.01 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of vitreous body and globe (H43-H44).
What cannot be coded together with H43.01?: H43.01 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 H43.01 (H43.0) and apply to it just the same.