Important Note:
This page is for our commercial plans only for services prior to 1/1/2022.
The diagnoses within these articles are for Dates of Services prior to 2022. For dates of services on and after January 1, 2022, please go to www.eyemedinfocus.com.
When an ophthalmological exam only is performed to diagnose or treat an HMSA member with one of the minor conditions listed below, the member’s plan benefits for medical services will be applied. If the service is paid under the member’s medical plan, the service will not be applied to the patient’s maximum benefits for vision services under his or her vision rider.
When an ophthalmological exam and refraction are performed to diagnose or treat an HMSA member for one of the listed minor conditions, the member’s vision rider benefits for vision services will be applied. If the member does not have a vision rider or has exhausted his or her vision rider benefits for the year, the member will be responsible for payment.
| ICD-9-CM code | Description | ICD-10-CM Code | Description |
|---|---|---|---|
| 021.3 | Oculoglandular tularemia | A21.1 | Oculoglandular tularemia |
| 032.81 | Conjunctival diphtheria | A36.86 | Diphtheritic conjunctivitis |
| 036.89 | Other specified meningococcal infections | A39.89 | Other meningococcal infections |
| 052.7 | Chickenpox, with other specified complications |
B01.0 B01.81 B01.89 |
Varicella meningitis Varicella keratitis Other varicella complications |
| 055.71 | Measles keratoconjunctivitis | B05.81 | Measles keratitis and keratoconjunctivitis |
| 076.0 - 076.1 | Trachoma |
A71.0 A71.1 |
Initial stage of trachoma Active stage of trachoma |
| 077.0 | Inclusion conjunctivitis | A74.0 | Chlamydial conjunctivitis |
| 077.1 | Epidemic keratoconjunctivitis | B30.0 | Keratoconjunctivitis due to adenovirus |
| 077.2 | Pharyngoconjunctival fever | B30.2 | Viral pharyngoconjunctivitis |
| 077.3 | Other adenoviral conjunctivitis | B30.1 | Conjunctivitis due to adenovirus |
| 077.4 | Epidemic hemorrhagic conjunctivitis | B30.3 | Acute epidemic hemorrhagic conjunctivitis (enteroviral) |
| 077.8 | Other viral conjunctivitis | B30.8 | Other viral conjunctivitis |
| 077.98 - 077.99 | Unspecified diseases of conjunctiva due to viruses and Chlamydiae |
A74.0 A74.89 B30.9 |
Chlamydial conjunctivitis Other chlamydial diseases Viral conjunctivitis, unspecified |
| 085.5 | Leishmaniasis, mucocutaneous (American) | B55.2 | Mucocutaneous leishmaniasis |
| 098.40 - 098.49 | Gonococcal conjunctivitis (neonatorum) | A54.30-A54.39 | Gonococcal infection of eye |
| 130.1 | Conjunctivitis due to toxoplasmosis | B58.09 | Other toxoplasma oculopathy |
| 139.1 | Late effects of trachoma | B94.0 | Sequelae of trachoma |
| 264.4 | Vitamin A deficiency with keratomalacia | E50.4 | Vitamin A deficiency with keratomalacia |
| 366.12 | Incipient cataract |
H25.091 H25.092 H25.093 |
Other age-related incipient cataract, right eye Other age-related incipient cataract, left eye Other age-related incipient cataract, bilateral |
| 368.10 - 368.16 | Subjective visual disturbances |
H53.10-H53.19 R44.1 R48.3 |
Subjective visual disturbances Visual hallucinations Visual agnosia |
| 368.30 - 368.34 | Other disorders of binocular vision | H53.30-H53.34 | Other and unspecified disorders of binocular vision |
| 368.51 - 368.53 | Color vision deficiencies |
H53.53 H53.54 H53.55 |
Deuteranomaly Protanomaly Tritanomaly |
| 368.55 - 368.59 | Color vision deficiencies |
H53.50 H53.52 H53.59 |
Unspecified color vision deficiencies Acquired color vision deficiency Other color vision deficiencies |
| 368.60-368.69 | Night blindness |
H53.60 H53.61 H53.62 H53.69 |
Unspecified night blindness Abnormal dark adaptation curve Acquired night blindness Other night blindness |
| 372.00-372.62, 372.71-372.9 | Disorders of conjunctiva |
B60.12 H10.011-H10.9 H11.001-H11.229, H11.30-H11.9 |
Conjunctivitis due to Acanthamoeba Conjunctivitis Other disorders of conjunctiva |
| 373.00 - 373.9 | Inflammation of eyelids |
H00.011-H00.19 H01.001-H01.9 |
Hordeolum and chalazion Other inflammation of eyelid |
| 374.50-374.86 | Degenerative disorders of eyelid and periocular area and other disorders of eyelid |
H02.60-H02.66 H02.70-H02.79 H02.811-H02.829, H02.841-H02.9 |
Xanthelasma of eyelid Other and unspecified degenerative disorders of eyelid and periocular area Other specified disorders of eyelid |
| 375.11-375.16 | Other disorders of lacrimal gland | H04.111-H04.169 | Other disorders of lacrimal gland |
| 375.20-375.22 | Epiphora | H04.211-H04.229 | Epiphora |
| 378.84 | Convergence excess or spasm | H51.12 | Convergence excess |
| 379.8-379.90 | Other and unspecified disorders of eye and adnexa | N/A | N/A |
| 379.93 | Redness or discharge of eye | N/A | N/A |
| 379.99 | Other ill-defined disorders of eye | N/A | N/A |
Information
For more information, see Ophthalmological Exam - With or Without Refraction.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |