Is H49.43 a billable ICD-10-CM code?

Yes. H49.43 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H49.43 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of ocular muscles, binocular movement, accommodation and refraction (H49-H52).

What cannot be coded together with H49.43?

H49.43 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 H49.43 (H49.4) and apply to it just the same.

H49.43

H49.43 — Progressive external ophthalmoplegia, bilateral

Billable / specific codeICD-10-CMbilateral

H49.43 is a billable, specific ICD-10-CM code for progressive external ophthalmoplegia, bilateral. It is valid for submission on a claim.

Excludes1 inherited from the categories above H49.43

These are not written on H49.43, but they bind it: a note on a category applies to every code beneath it. Billing H49.43 with anything listed here is a denial.

Written on H49.4 — Progressive external ophthalmoplegia

Kearns-Sayre syndrome (H49.81-)

Excludes2 inherited from the categories above H49.43

Also inherited, and the opposite of Excludes1: these conditions are not part of H49.43, but a patient can have both, so you may code both.

Written on H49 — Paralytic strabismus

internal ophthalmoplegia (H52.51-)
internuclear ophthalmoplegia (H51.2-)
progressive supranuclear ophthalmoplegia (G23.1)

Risk adjustment

H49.43 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

H49.43 is named in 31 Medicare coverage policies — 31 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
A54095Billing and Coding: Nerve Conduction Studies and Electromyography
A54969Billing and Coding: Nerve Conduction Studies and Electromyography
A56551Billing and Coding: Visual Fields Testing

Code history

H49.43 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 H49.4. If H49.43 is not quite right, the correct code is usually one of these.

Questions about H49.43

Is H49.43 a billable ICD-10-CM code?: Yes. H49.43 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H49.43 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of ocular muscles, binocular movement, accommodation and refraction (H49-H52).
What cannot be coded together with H49.43?: H49.43 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 H49.43 (H49.4) and apply to it just the same.