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

ICD-10 H21.01

Billable / Specific

Hyphema, right eye

H21
Block
0
Synonyms
22
LCDs
6
Payer Policies
0
Linked CPTs

About ICD-10-CM H21.01

ICD-10-CM code H21.01 represents Hyphema, right eye. This is a billable/specific code in the Eye and Adnexa chapter (block H21). The 2026 edition of ICD-10-CM H21.01 became effective on October 1, 2025.

Medicare LCD Coverage for H21.01

Local Coverage Determinations (LCDs) from CMS MACs that list H21.01 as a covered diagnosis.

22 LCDs

Showing top 10 of 22 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92201 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92250 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92202 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92227 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92228 →
CMS LCD: Billing and Coding: Ocular Photography - External
Article ID: 57068, Effective: 2025-10-01 00:00:00, 1056 covered, 0 non-covered
CPT 92285 →
CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Article ID: 56726, Effective: 2025-10-01 00:00:00, 1480 covered, 0 non-covered
CPT 92201 →
CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Article ID: 56726, Effective: 2025-10-01 00:00:00, 1480 covered, 0 non-covered
CPT 92250 →
CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Article ID: 56726, Effective: 2025-10-01 00:00:00, 1480 covered, 0 non-covered
CPT 92202 →
CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Article ID: 56726, Effective: 2025-10-01 00:00:00, 1480 covered, 0 non-covered
CPT 92227 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing H21.01.

6 policies

5 Medicare

Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Policy ID: ART-53060
Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Policy ID: ART-56726
Billing and Coding: Ocular Photography - External
Policy ID: ART-57068
Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Policy ID: ART-57071
Billing and Coding: Visual Fields
Policy ID: ART-57483

CPT Codes Commonly Billed with H21.01

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

No procedure linkages on file for H21.01

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 H21.01 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
H21.01 36441 10000

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

ICD-10 H21.01, Billing FAQ

Is ICD-10 code H21.01 billable? +

Yes, H21.01 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What ICD-9 codes does H21.01 map to? +

Per CMS GEMs, H21.01 maps to ICD-9 codes: 36441. 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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