ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 H04.211

Billable / Specific

Epiphora due to excess lacrimation, right lacrimal gland

H04
Block
0
Synonyms
0
LCDs
1
Payer Policies
0
Linked CPTs

About ICD-10-CM H04.211

ICD-10-CM code H04.211 represents Epiphora due to excess lacrimation, right lacrimal gland. This is a billable/specific code in the Eye and Adnexa chapter (block H04). The 2026 edition of ICD-10-CM H04.211 became effective on October 1, 2025.

Medicare LCD Coverage for H04.211

Local Coverage Determinations (LCDs) from CMS MACs that list H04.211 as a covered diagnosis.

No Medicare LCDs reference H04.211 as covered

This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.

Commercial Payer Coverage

Coverage policies from major commercial payers referencing H04.211.

1 policies

1 Cigna

Diagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy - (0554)
Policy ID: MM_0554

CPT Codes Commonly Billed with H04.211

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for H04.211

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert H04.211 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
H04.211 37521 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 H04.211, Billing FAQ

Is ICD-10 code H04.211 billable? +

Yes, H04.211 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What ICD-9 codes does H04.211 map to? +

Per CMS GEMs, H04.211 maps to ICD-9 codes: 37521. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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