S05.42XA: Penetrating wound of orbit with or without foreign body, left eye, initial encounter
S05.42XA, penetrating wound of orbit with or without foreign body, left eye, initial encounter, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 41 HCPCS Level II codes, including J1670 (Injection, tetanus immune globulin, human, up to 250 units), C8900 (Magnetic resonance angiography with contrast, abdomen), C8901 (Magnetic resonance angiography without contrast, abdomen). The articles come from 4 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 S05.42XA as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J1670 | Injection, tetanus immune globulin, human, up to 250 units | Special coverage instructions apply | — | 2 |
| C8900 | Magnetic resonance angiography with contrast, abdomen | Special coverage instructions apply | — | 1 |
| C8901 | Magnetic resonance angiography without contrast, abdomen | Special coverage instructions apply | — | 1 |
| C8902 | Magnetic resonance angiography without contrast followed by with contrast, abdomen | Special coverage instructions apply | — | 1 |
| C8909 | Magnetic resonance angiography with contrast, chest (excluding myocardium) | Special coverage instructions apply | — | 1 |
| C8910 | Magnetic resonance angiography without contrast, chest (excluding myocardium) | Special coverage instructions apply | — | 1 |
| C8911 | Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium) | Special coverage instructions apply | — | 1 |
| C8912 | Magnetic resonance angiography with contrast, lower extremity | Special coverage instructions apply | — | 1 |
| C8913 | Magnetic resonance angiography without contrast, lower extremity | Special coverage instructions apply | — | 1 |
| C8914 | Magnetic resonance angiography without contrast followed by with contrast, lower extremity | Special coverage instructions apply | — | 1 |
| C8918 | Magnetic resonance angiography with contrast, pelvis | Special coverage instructions apply | — | 1 |
| C8919 | Magnetic resonance angiography without contrast, pelvis | Special coverage instructions apply | — | 1 |
| C8920 | Magnetic resonance angiography without contrast followed by with contrast, pelvis | Special coverage instructions apply | — | 1 |
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin | Carrier judgment | — | 1 |
| J1569 | Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mg | Special coverage instructions apply | — | 1 |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 1 |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1557 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1556 | Injection, immune globulin (bivigam), 500 mg | Carrier judgment | — | 1 |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | Special coverage instructions apply | — | 1 |
| J1554 | Injection, immune globulin (asceniv), 500 mg | Carrier judgment | — | 1 |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg | Carrier judgment | — | 1 |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 1 |
| J1460 | Injection, gamma globulin, intramuscular, 1 cc | Special coverage instructions apply | — | 1 |
16 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing S05.42XA
- A56805: Billing and Coding: Magnetic Resonance Angiography (MRA) (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 12 Level II codes). LCD with the same title: L33633, L34372, L34865
- A57554: Billing and Coding: Immune Globulins (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 20 Level II codes). LCD with the same title: L34771
- A52438: Billing and Coding: Tetanus Immunization (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 1 Level II codes)
- A54767: Billing and Coding: Medicare Preventive Coverage for Certain Vaccines (Palmetto GBA (MAC - Part A, MAC - Part B); 9 Level II codes)
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 S05 diagnoses (Injury of eye and orbit)
- S05.41XA — Penetrating wound of orbit with or without foreign body, right eye…
- S05.21XA — Ocular laceration and rupture with prolapse or loss of intraocular…
- S05.22XA — Ocular laceration and rupture with prolapse or loss of intraocular…
- S05.31XA — Ocular laceration without prolapse or loss of intraocular tissue…
- S05.32XA — Ocular laceration without prolapse or loss of intraocular tissue…
- S05.51XA — Penetrating wound with foreign body of right eyeball, initial…
- S05.52XA — Penetrating wound with foreign body of left eyeball, initial encounter
- S05.61XA — Penetrating wound without foreign body of right eyeball, initial…
- S05.62XA — Penetrating wound without foreign body of left eyeball, initial…
- S05.71XA — Avulsion of right eye, initial encounter
- S05.72XA — Avulsion of left eye, initial encounter
Frequently asked questions
Does Medicare cover S05.42XA (Penetrating wound of orbit with or without foreign body…)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list S05.42XA as a covered diagnosis for 41 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 S05.42XA?
The Level II codes from the policies most specific to this diagnosis are J1670 (Injection, tetanus immune globulin, human, up to 250 units, 2 articles); C8900 (Magnetic resonance angiography with contrast, abdomen, 1 article); C8901 (Magnetic resonance angiography without contrast, abdomen, 1 article); C8902 (Magnetic resonance angiography without contrast followed…, 1 article); C8909 (Magnetic resonance angiography with contrast, chest…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list S05.42XA?
A56805 (Billing and Coding: Magnetic Resonance Angiography (MRA)); A57554 (Billing and Coding: Immune Globulins); A52438 (Billing and Coding: Tetanus Immunization), and 1 more article.
What is ICD-10-CM code S05.42XA?
S05.42XA is the ICD-10-CM code for penetrating wound of orbit with or without foreign body, left eye, initial encounter, in category S05 (Injury of eye and orbit), chapter 19: Injury, poisoning and other consequences of external causes.
Next steps
- Run a reimbursement report for a device billed under J1670
- Watch J1670 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1670
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 19: Injury, poisoning and other consequences of external causes · All diagnoses · HCPCS lookup