ICD-10 H43.0
Non-Billable HeaderVitreous prolapse
About ICD-10-CM H43.0
ICD-10-CM code H43.0 represents Vitreous prolapse. This is a non-billable header code in the Eye and Adnexa chapter (block H43). The 2026 edition of ICD-10-CM H43.0 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 H43.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- vitreous syndrome following cataract surgery (H59.0-)
- traumatic vitreous prolapse (S05.2-)
Medicare LCD Coverage for H43.0
Local Coverage Determinations (LCDs) from CMS MACs that list H43.0 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 H43.0.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but H43.0 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with H43.0
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.
Codes Adjacent To H43.0
Other codes in section H43-H44 (Disorders of vitreous body and globe).
ICD-10 H43.0, Billing FAQ
Is ICD-10 code H43.0 billable? +
No, H43.0 is a non-billable header code. Use a more specific child code from block H43 when submitting claims.
What codes are Type 1 Excludes for H43.0? +
Type 1 Excludes (never code together with H43.0): vitreous syndrome following cataract surgery (H59.0-); traumatic vitreous prolapse (S05.2-)
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team