ICD-10 H36
Non-Billable HeaderRetinal disorders in diseases classified elsewhere
About ICD-10-CM H36
ICD-10-CM code H36 represents Retinal disorders in diseases classified elsewhere. This is a non-billable header code in the Eye and Adnexa chapter (block H36). The 2026 edition of ICD-10-CM H36 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with H36. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- arteriosclerotic retinopathy (H35.0-)
- diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)
Coding Notes
Code First
- underlying disease, such as:
- lipid storage disorders (E75.-)
- sickle-cell disorders (D57.-)
Medicare LCD Coverage for H36
Local Coverage Determinations (LCDs) from CMS MACs that list H36 as a covered diagnosis.
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 H36.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but H36 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with H36
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
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 H36 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| H36 | 36271 | 10000 |
| H36 | 36272 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To H36
Other codes in section H30-H36 (Disorders of choroid and retina).
ICD-10 H36, Billing FAQ
Is ICD-10 code H36 billable? +
No, H36 is a non-billable header code. Use a more specific child code from block H36 when submitting claims.
What codes are Type 1 Excludes for H36? +
Type 1 Excludes (never code together with H36): arteriosclerotic retinopathy (H35.0-); diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)
What ICD-9 codes does H36 map to? +
Per CMS GEMs, H36 maps to ICD-9 codes: 36271, 36272. 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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