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

ICD-10 H42

Billable / Specific

Glaucoma in diseases classified elsewhere

H42
Block
0
Synonyms
44
LCDs
13
Payer Policies
0
Linked CPTs

About ICD-10-CM H42

ICD-10-CM code H42 represents Glaucoma in diseases classified elsewhere. This is a billable/specific code in the Eye and Adnexa chapter (block H42). The 2026 edition of ICD-10-CM H42 became effective on October 1, 2025.

Type 1 Excludes

Pure excludes, these codes can never be coded together with H42. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • glaucoma (in) onchocerciasis (B73.02)
  • glaucoma (in) syphilis (A52.71)
  • glaucoma (in) tuberculous (A18.59)
  • neovascular secondary angle closure glaucoma (H40.84-)

Coding Notes

Code First

  • underlying condition, such as:
  • amyloidosis (E85.-)
  • aniridia (Q13.1)
  • glaucoma (in) diabetes mellitus (E08.39, E09.39, E10.39, E11.39, E13.39)
  • Lowe's syndrome (E72.03)
  • Rieger anomaly (Q13.81)
  • specified metabolic disorder (E70-E88)

Medicare LCD Coverage for H42

Local Coverage Determinations (LCDs) from CMS MACs that list H42 as a covered diagnosis.

44 LCDs

Showing top 10 of 44 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: Corneal Pachymetry
Article ID: 56457, Effective: 2026-01-22 00:00:00, 217 covered, 0 non-covered
CPT 76514 →
CMS LCD: Billing and Coding: Visual Fields Testing
Article ID: 56551, Effective: 2025-10-01 00:00:00, 1427 covered, 0 non-covered
CPT 92082 →
CMS LCD: Billing and Coding: Visual Fields Testing
Article ID: 56551, Effective: 2025-10-01 00:00:00, 1427 covered, 0 non-covered
CPT 92083 →
CMS LCD: Billing and Coding: Visual Fields Testing
Article ID: 56551, Effective: 2025-10-01 00:00:00, 1427 covered, 0 non-covered
CPT 92081 →
CMS LCD: Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Article ID: 56692, Effective: 2025-10-01 00:00:00, 720 covered, 0 non-covered
CPT 92134 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing H42.

13 policies

5 Medicare

Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Policy ID: ART-53060
Billing and Coding: Corneal Pachymetry
Policy ID: ART-56457
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Policy ID: ART-56537
Billing and Coding: Corneal Pachymetry
Policy ID: ART-56548
Billing and Coding: Visual Fields Testing
Policy ID: ART-56551

CPT Codes Commonly Billed with H42

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

No procedure linkages on file for H42

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 H42 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
H42 36544 10000

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

ICD-10 H42, Billing FAQ

Is ICD-10 code H42 billable? +

Yes, H42 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What codes are Type 1 Excludes for H42? +

Type 1 Excludes (never code together with H42): glaucoma (in) onchocerciasis (B73.02); glaucoma (in) syphilis (A52.71); glaucoma (in) tuberculous (A18.59)

What ICD-9 codes does H42 map to? +

Per CMS GEMs, H42 maps to ICD-9 codes: 36544. 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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