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

ICD-10 H35.52

Billable / Specific

Pigmentary retinal dystrophy

H35
Block
3
Synonyms
78
LCDs
22
Payer Policies
5
Linked CPTs

About ICD-10-CM H35.52

ICD-10-CM code H35.52 represents Pigmentary retinal dystrophy. This is a billable/specific code in the Eye and Adnexa chapter (block H35). The 2026 edition of ICD-10-CM H35.52 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under H35.52. Per CMS ICD-10-CM Tabular 2026.

  • Albipunctate retinal dystrophy
  • Retinitis pigmentosa
  • Tapetoretinal dystrophy

Medicare LCD Coverage for H35.52

Local Coverage Determinations (LCDs) from CMS MACs that list H35.52 as a covered diagnosis.

78 LCDs

Showing top 10 of 78 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: Electroretinography (ERG)
Article ID: 57677, Effective: 2024-10-01 00:00:00, 653 covered, 1 non-covered
CPT 92274 →
CMS LCD: Billing and Coding: Electroretinography (ERG)
Article ID: 57677, Effective: 2024-10-01 00:00:00, 653 covered, 1 non-covered
CPT 0509T →
CMS LCD: Billing and Coding: Electroretinography (ERG)
Article ID: 57677, Effective: 2024-10-01 00:00:00, 653 covered, 1 non-covered
CPT 92273 →
CMS LCD: Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Article ID: 57804, Effective: 2025-10-01 00:00:00, 725 covered, 1 non-covered
CPT 92134 →
CMS LCD: Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Article ID: 57804, Effective: 2025-10-01 00:00:00, 725 covered, 1 non-covered
CPT 92132 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing H35.52.

22 policies

5 Medicare

Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Policy ID: ART-53060
Billing and Coding: ArgusM II Retinal Prosthesis System
Policy ID: ART-54327
Billing and Coding: Voretigene Neparvovec-rzyl (Luxturna�)
Policy ID: ART-56419
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Policy ID: ART-56537
Billing and Coding: Visual Fields Testing
Policy ID: ART-56551

CPT Codes Commonly Billed with H35.52

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

5 linkages
  • 0100T CMS LCD: Billing and Coding: ArgusM II Retinal Prosthesis System CMS LCD
  • L8608 CMS LCD: Billing and Coding: ArgusM II Retinal Prosthesis System CMS LCD
  • 67299 CMS LCD: Billing and Coding: Voretigene Neparvovec-rzyl (Luxturna�) CMS LCD
  • J3398 CMS LCD: Billing and Coding: Voretigene Neparvovec-rzyl (Luxturna�) CMS LCD
  • 67036 CMS LCD: Billing and Coding: Voretigene Neparvovec-rzyl (Luxturna�) CMS LCD

Convert H35.52 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
H35.52 36274 00000

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

ICD-10 H35.52, Billing FAQ

Is ICD-10 code H35.52 billable? +

Yes, H35.52 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to H35.52? +

ICD-10 H35.52 includes: Albipunctate retinal dystrophy; Retinitis pigmentosa; Tapetoretinal dystrophy.

What CPT codes are commonly billed with H35.52? +

Procedures frequently paired with H35.52 include: 0100T, L8608, 67299, J3398, 67036.

What ICD-9 codes does H35.52 map to? +

Per CMS GEMs, H35.52 maps to ICD-9 codes: 36274. 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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