H35.81: Retinal edema

H35.81, retinal edema, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 26 HCPCS Level II codes, including J3590 (Unclassified biologics), C9257 (Injection, bevacizumab, 0.25 mg), J2777 (Injection, faricimab-svoa, 0.1 mg). The articles come from 2 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 H35.81 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
J3590Unclassified biologicsCarrier judgment—2
C9257Injection, bevacizumab, 0.25 mgSpecial coverage instructions apply—2
J2777Injection, faricimab-svoa, 0.1 mgCarrier judgment—1
J0178Injection, aflibercept, 1 mgCarrier judgment—1
J0177Injection, aflibercept hd, 1 mgCarrier judgment—1
Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mgCarrier judgment—1
J2778Injection, ranibizumab, 0.1 mgCarrier judgment—1
J3490Unclassified drugsSpecial coverage instructions apply—1
Q5124Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mgCarrier judgment—1
J0179Injection, brolucizumab-dbll, 1 mgCarrier judgment—1
J2779Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mgCarrier judgment—1
C9399Unclassified drugs or biologicalsSpecial coverage instructions apply—1
Q5147Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mgCarrier judgment—1
Q5149Injection, aflibercept-abzv (enzeevu), biosimilar, 1 mgCarrier judgment—1
Q5150Injection, aflibercept-mrbb (ahzantive), biosimilar, 1 mgCarrier judgment—1
Q5153Injection, aflibercept-yszy (opuviz), biosimilar, 1 mgCarrier judgment—1
Q5155Injection, aflibercept-jbvf (yesafili), biosimilar, 1 mgCarrier judgment—1
Q5168Injection, ranibizumab-leyk (nufymco), biosimilar, 0.1 mgCarrier judgment—1
Q5170Injection, aflibercept-boav (eydenzelt), biosimilar, 1 mgCarrier judgment—1
J7999Compounded drug, not otherwise classifiedSpecial coverage instructions apply—1
Q5129Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mgCarrier judgment—1
Q5126Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mgCarrier judgment—1
Q5118Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mgCarrier judgment—1
Q5107Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mgSpecial coverage instructions apply—1
J9035Injection, bevacizumab, 10 mgCarrier judgment—1

1 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing H35.81

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 H35 diagnoses (Other retinal disorders)

Frequently asked questions

Does Medicare cover H35.81 (Retinal edema)?

Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list H35.81 as a covered diagnosis for 26 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 H35.81?

The Level II codes from the policies most specific to this diagnosis are J3590 (Unclassified biologics, 2 articles); C9257 (Injection, bevacizumab, 0.25 mg, 2 articles); J2777 (Injection, faricimab-svoa, 0.1 mg, 1 article); J0178 (Injection, aflibercept, 1 mg, 1 article); J0177 (Injection, aflibercept hd, 1 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list H35.81?

A52451 (Billing and Coding: Ranibizumab, Aflibercept and biosimilars); A53008 (Billing and Coding: Intraocular Bevacizumab); A52370 (Billing and Coding: Bevacizumab and biosimilars).

What is ICD-10-CM code H35.81?

H35.81 is the ICD-10-CM code for retinal edema, in category H35 (Other retinal disorders), chapter 7: Diseases of the eye and adnexa.

Next steps

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