Z96.1

Z96.1: Presence of intraocular lens

Billable / specific codeICD-10-CM

Z96.1 is a billable, specific ICD-10-CM code for presence of intraocular lens. It is valid for submission on a claim.

Check Z96.1 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Presence of pseudophakia

Excludes2 inherited from the categories above Z96.1

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

Written on Z96: Presence of other functional implants

complications of internal prosthetic devices, implants and grafts (T82-T85)
fitting and adjustment of prosthetic and other devices (Z44-Z46)

Other codes that can never be billed with Z96.1

Their own Excludes1 notes name this code, so the conflict is not listed above.

H27Other disorders of lens
H59Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified
Z18Retained foreign body fragments

Risk adjustment

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

Medicare coverage

Z96.1 is named in 2 Medicare coverage policies: 2 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52499Refractive Lenses - Policy Article
A57070Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation

Alphabetic index entries that lead here

Pseudophakia
Presence›intraocular lens(functional)
Replacement by artificial or mechanical device or prosthesis of›lens
Status›pseudophakia
Presence›artificial›lens(intraocular)
Presence›implanted device›intraocular lens
Status›organ replacement›by artificial or mechanical device or prosthesis of›lens

Code history

Unchanged in every release from FY2024 to FY2027.