H49.32: Total (external) ophthalmoplegia, left eye
H49.32, total (external) ophthalmoplegia, left eye, is listed as a covered diagnosis in 15 Medicare billing and coding articles that apply to 16 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 7 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 H49.32 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 | — | 8 |
| J0588 | Injection, incobotulinumtoxin a, 1 unit | Carrier judgment | — | 8 |
| J0586 | Injection, abobotulinumtoxina, 5 units | Carrier judgment | — | 8 |
| J0587 | Injection, rimabotulinumtoxinb, 100 units | Special coverage instructions apply | — | 8 |
| J0589 | Injection, daxibotulinumtoxina-lanm, 1 unit | Carrier judgment | — | 8 |
| G0278 | Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure) | Carrier judgment | — | 1 |
| G2187 | Patients with clinical indications for imaging of the head: head trauma | Carrier judgment | — | 1 |
| G2188 | Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age | Carrier judgment | — | 1 |
| G2189 | Patients with clinical indications for imaging of the head: abnormal neurologic exam | Carrier judgment | — | 1 |
| G2190 | Patients with clinical indications for imaging of the head: headache radiating to the neck | Carrier judgment | — | 1 |
| G2191 | Patients with clinical indications for imaging of the head: positional headaches | Carrier judgment | — | 1 |
| G2192 | Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age | Carrier judgment | — | 1 |
| G2193 | Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age) | Carrier judgment | — | 1 |
| G2194 | Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior | Carrier judgment | — | 1 |
| G2195 | Patients with clinical indications for imaging of the head: occipital headache in children | Carrier judgment | — | 1 |
| G0255 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve | Non-covered by Medicare | Not covered | 5 |
Medicare policy articles listing H49.32
- A57715: Billing and Coding: Botulinum Toxins (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L33274, L38809
- A58423: Billing and Coding: Botulinum Toxins (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L33274, L38809
- 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
- A57307: Billing and Coding: Nerve Conduction Studies and Electromyography (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57478: Billing and Coding: Nerve Conduction Studies and Electromyography (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57056: Billing and Coding: Aortography and Peripheral Angiography (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L36767
- A54969: Billing and Coding: Nerve Conduction Studies and Electromyography (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A57668: Billing and Coding: Nerve Conduction Studies and Electromyography (Wellpoint Federal (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A56619: Billing and Coding: Nerve Conduction Studies and Electromyography (Palmetto GBA (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34594, L34859, L35048, L35081
- A56612: Billing and Coding: CT of the Head (Palmetto GBA (MAC - Part A, MAC - Part B); 9 Level II codes). LCD with the same title: L34417
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 H49 diagnoses (Paralytic strabismus)
- H49.31 — Total (external) ophthalmoplegia, right eye
- H49.33 — Total (external) ophthalmoplegia, bilateral
- H49.01 — Third [oculomotor] nerve palsy, right eye
- H49.02 — Third [oculomotor] nerve palsy, left eye
- H49.03 — Third [oculomotor] nerve palsy, bilateral
- H49.11 — Fourth [trochlear] nerve palsy, right eye
- H49.12 — Fourth [trochlear] nerve palsy, left eye
- H49.13 — Fourth [trochlear] nerve palsy, bilateral
- H49.21 — Sixth [abducent] nerve palsy, right eye
- H49.22 — Sixth [abducent] nerve palsy, left eye
- H49.23 — Sixth [abducent] nerve palsy, bilateral
- H49.41 — Progressive external ophthalmoplegia, right eye
- H49.42 — Progressive external ophthalmoplegia, left eye
- H49.43 — Progressive external ophthalmoplegia, bilateral
- H49.881 — Other paralytic strabismus, right eye
- H49.882 — Other paralytic strabismus, left eye
- H49.883 — Other paralytic strabismus, bilateral
- H49.9 — Unspecified paralytic strabismus
Frequently asked questions
Does Medicare cover H49.32 (Total (external) ophthalmoplegia, left eye)?
Medicare covers items and services, not diagnoses. 15 Medicare billing and coding articles list H49.32 as a covered diagnosis for 16 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 H49.32?
The Level II codes from the policies most specific to this diagnosis are J0585 (Injection, onabotulinumtoxina, 1 unit, 8 articles); J0588 (Injection, incobotulinumtoxin a, 1 unit, 8 articles); J0586 (Injection, abobotulinumtoxina, 5 units, 8 articles); J0587 (Injection, rimabotulinumtoxinb, 100 units, 8 articles); J0589 (Injection, daxibotulinumtoxina-lanm, 1 unit, 8 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list H49.32?
A57715 (Billing and Coding: Botulinum Toxins); A58423 (Billing and Coding: Botulinum Toxins); A57185 (Billing and Coding: Botulinum Toxin Injections), and 12 more articles.
What is ICD-10-CM code H49.32?
H49.32 is the ICD-10-CM code for total (external) ophthalmoplegia, left eye, in category H49 (Paralytic strabismus), 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