Is H04.213 a billable ICD-10-CM code?

Yes. H04.213 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H04.213 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of eyelid, lacrimal system and orbit (H00-H05).

H04.213

H04.213 — Epiphora due to excess lacrimation, bilateral lacrimal glands

Billable / specific codeICD-10-CMbilateral

H04.213 is a billable, specific ICD-10-CM code for epiphora due to excess lacrimation, bilateral lacrimal glands. It is valid for submission on a claim.

Risk adjustment

H04.213 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

H04.213 is named in 1 Medicare coverage policy — 0 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A57284Billing and Coding: Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigationnot covered

Code history

H04.213 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share H04.21. If H04.213 is not quite right, the correct code is usually one of these.

Questions about H04.213

Is H04.213 a billable ICD-10-CM code?: Yes. H04.213 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H04.213 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of eyelid, lacrimal system and orbit (H00-H05).