H02.041: Spastic entropion of right upper eyelid
H02.041, spastic entropion of right upper eyelid, is listed as a covered diagnosis in 6 Medicare billing and coding articles that apply to 5 HCPCS Level II codes, including J0585 (Injection, onabotulinumtoxina, 1 unit), J0588 (Injection, incobotulinumtoxin a, 1 unit), J0586 (Injection, abobotulinumtoxina, 5 units). The articles come from 5 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with H02.041 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J0585 | Injection, onabotulinumtoxina, 1 unit | Special coverage instructions apply | — | 6 |
| J0588 | Injection, incobotulinumtoxin a, 1 unit | Carrier judgment | — | 6 |
| J0586 | Injection, abobotulinumtoxina, 5 units | Carrier judgment | — | 6 |
| J0587 | Injection, rimabotulinumtoxinb, 100 units | Special coverage instructions apply | — | 6 |
| J0589 | Injection, daxibotulinumtoxina-lanm, 1 unit | Carrier judgment | — | 6 |
Medicare policy articles listing H02.041
- A57185: Billing and Coding: Botulinum Toxin Injections (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
- A57186: Billing and Coding: Botulinum Toxin Injections (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
- A59707: Billing and Coding: Botulinum Toxin Injections (Wellpoint Federal (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
- A59714: Billing and Coding: Botulinum Toxin Injections (Palmetto GBA (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
- A59726: Billing and Coding: Botulinum Toxins Injections (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 5 Level II codes)
- A59809: Billing and Coding: Botulinum Toxin Injections (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35170, L35172, L39832, L39836
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other H02 diagnoses (Other disorders of eyelid)
- H02.042 — Spastic entropion of right lower eyelid
- H02.044 — Spastic entropion of left upper eyelid
- H02.045 — Spastic entropion of left lower eyelid
- H02.141 — Spastic ectropion of right upper eyelid
- H02.142 — Spastic ectropion of right lower eyelid
- H02.144 — Spastic ectropion of left upper eyelid
- H02.145 — Spastic ectropion of left lower eyelid
- H02.431 — Paralytic ptosis of right eyelid
- H02.432 — Paralytic ptosis of left eyelid
- H02.433 — Paralytic ptosis of bilateral eyelids
Frequently asked questions
Does Medicare cover H02.041 (Spastic entropion of right upper eyelid)?
Medicare covers items and services, not diagnoses. 6 Medicare billing and coding articles list H02.041 as a covered diagnosis for 5 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 H02.041?
The Level II codes from the policies most specific to this diagnosis are J0585 (Injection, onabotulinumtoxina, 1 unit, 6 articles); J0588 (Injection, incobotulinumtoxin a, 1 unit, 6 articles); J0586 (Injection, abobotulinumtoxina, 5 units, 6 articles); J0587 (Injection, rimabotulinumtoxinb, 100 units, 6 articles); J0589 (Injection, daxibotulinumtoxina-lanm, 1 unit, 6 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list H02.041?
A57185 (Billing and Coding: Botulinum Toxin Injections); A57186 (Billing and Coding: Botulinum Toxin Injections); A59707 (Billing and Coding: Botulinum Toxin Injections), and 3 more articles.
What is ICD-10-CM code H02.041?
H02.041 is the ICD-10-CM code for spastic entropion of right upper eyelid, in category H02 (Other disorders of eyelid), chapter 7: Diseases of the eye and adnexa.
Next steps
- Run a reimbursement report for a device billed under J0585
- Watch J0585 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0585
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 7: Diseases of the eye and adnexa · All diagnoses · HCPCS lookup