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

ICD-10 H21.1X1

Billable / Specific

Other vascular disorders of iris and ciliary body, right eye

H21
Block
0
Synonyms
37
LCDs
10
Payer Policies
0
Linked CPTs

About ICD-10-CM H21.1X1

ICD-10-CM code H21.1X1 represents Other vascular disorders of iris and ciliary body, right eye. This is a billable/specific code in the Eye and Adnexa chapter (block H21). The 2026 edition of ICD-10-CM H21.1X1 became effective on October 1, 2025.

Medicare LCD Coverage for H21.1X1

Local Coverage Determinations (LCDs) from CMS MACs that list H21.1X1 as a covered diagnosis.

37 LCDs

Showing top 10 of 37 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: Intraocular Bevacizumab
Article ID: 53008, Effective: 2025-11-06 00:00:00, 341 covered, 0 non-covered
CPT 92134 →
CMS LCD: Billing and Coding: Intraocular Bevacizumab
Article ID: 53008, Effective: 2025-11-06 00:00:00, 341 covered, 0 non-covered
CPT 67028 →
CMS LCD: Billing and Coding: Intraocular Bevacizumab
Article ID: 53008, Effective: 2025-11-06 00:00:00, 341 covered, 0 non-covered
CPT C9257 →
CMS LCD: Billing and Coding: Intraocular Bevacizumab
Article ID: 53008, Effective: 2025-11-06 00:00:00, 341 covered, 0 non-covered
CPT J7999 →
CMS LCD: Billing and Coding: Panretinal (Scatter) Laser Photocoagulation
Article ID: 56594, Effective: 2026-03-26 00:00:00, 249 covered, 0 non-covered
CPT 67228 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing H21.1X1.

10 policies

5 Medicare

Billing and Coding: Bevacizumab and biosimilars
Policy ID: ART-52370
Billing and Coding: Intraocular Bevacizumab
Policy ID: ART-53008
Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Policy ID: ART-53060
Billing and Coding: Panretinal (Scatter) Laser Photocoagulation
Policy ID: ART-56550
Billing and Coding: Panretinal (Scatter) Laser Photocoagulation
Policy ID: ART-56594

CPT Codes Commonly Billed with H21.1X1

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

No procedure linkages on file for H21.1X1

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 H21.1X1 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
H21.1X1 36442 10000

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

ICD-10 H21.1X1, Billing FAQ

Is ICD-10 code H21.1X1 billable? +

Yes, H21.1X1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What ICD-9 codes does H21.1X1 map to? +

Per CMS GEMs, H21.1X1 maps to ICD-9 codes: 36442. 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 June 1, 2026.

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