CPT 92025: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 92025 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 92025 with a diagnosis that isn't covered typically denies as CARC 50 — not medically necessary.
National approximation. Coverage varies by MAC and state — confirm against the specific LCD/NCD and article that applies to your jurisdiction and date of service.
| ICD-10 | Description |
|---|---|
| H11.001 | Unspecified pterygium of right eye |
| H11.002 | Unspecified pterygium of left eye |
| H11.003 | Unspecified pterygium of eye, bilateral |
| H11.011 | Amyloid pterygium of right eye |
| H11.012 | Amyloid pterygium of left eye |
| H11.013 | Amyloid pterygium of eye, bilateral |
| H11.021 | Central pterygium of right eye |
| H11.022 | Central pterygium of left eye |
| H11.023 | Central pterygium of eye, bilateral |
| H11.031 | Double pterygium of right eye |
| H11.032 | Double pterygium of left eye |
| H11.033 | Double pterygium of eye, bilateral |
| H11.041 | Peripheral pterygium, stationary, right eye |
| H11.042 | Peripheral pterygium, stationary, left eye |
| H11.043 | Peripheral pterygium, stationary, bilateral |
| H11.051 | Peripheral pterygium, progressive, right eye |
| H11.052 | Peripheral pterygium, progressive, left eye |
| H11.053 | Peripheral pterygium, progressive, bilateral |
| H11.061 | Recurrent pterygium of right eye |
| H11.062 | Recurrent pterygium of left eye |
| H11.063 | Recurrent pterygium of eye, bilateral |
| H16.051 | Mooren's corneal ulcer, right eye |
| H16.052 | Mooren's corneal ulcer, left eye |
| H16.053 | Mooren's corneal ulcer, bilateral |
| H16.301 | Unspecified interstitial keratitis, right eye |
| H16.302 | Unspecified interstitial keratitis, left eye |
| H16.303 | Unspecified interstitial keratitis, bilateral |
| H16.321 | Diffuse interstitial keratitis, right eye |
| H16.322 | Diffuse interstitial keratitis, left eye |
| H16.323 | Diffuse interstitial keratitis, bilateral |
| H16.331 | Sclerosing keratitis, right eye |
| H16.332 | Sclerosing keratitis, left eye |
| H16.333 | Sclerosing keratitis, bilateral |
| H17.9 | Unspecified corneal scar and opacity |
| H18.11 | Bullous keratopathy, right eye |
| H18.12 | Bullous keratopathy, left eye |
| H18.13 | Bullous keratopathy, bilateral |
| H18.421 | Band keratopathy, right eye |
| H18.422 | Band keratopathy, left eye |
| H18.423 | Band keratopathy, bilateral |
| H18.451 | Nodular corneal degeneration, right eye |
| H18.452 | Nodular corneal degeneration, left eye |
| H18.453 | Nodular corneal degeneration, bilateral |
| H18.591 | Other hereditary corneal dystrophies, right eye |
| H18.592 | Other hereditary corneal dystrophies, left eye |
| H18.593 | Other hereditary corneal dystrophies, bilateral |
| H18.601 | Keratoconus, unspecified, right eye |
| H18.602 | Keratoconus, unspecified, left eye |
| H18.603 | Keratoconus, unspecified, bilateral |
| H18.611 | Keratoconus, stable, right eye |
| H18.612 | Keratoconus, stable, left eye |
| H18.613 | Keratoconus, stable, bilateral |
| H18.621 | Keratoconus, unstable, right eye |
| H18.622 | Keratoconus, unstable, left eye |
| H18.623 | Keratoconus, unstable, bilateral |
| H18.711 | Corneal ectasia, right eye |
| H18.712 | Corneal ectasia, left eye |
| H18.713 | Corneal ectasia, bilateral |
| H52.211 | Irregular astigmatism, right eye |
| H52.212 | Irregular astigmatism, left eye |
| H52.213 | Irregular astigmatism, bilateral |
| H53.2 | Diplopia |
| T85.21XA | Breakdown (mechanical) of intraocular lens, initial encounter |
| T85.22XA | Displacement of intraocular lens, initial encounter |
| T85.318A | Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, initial encounter |
| T85.328A | Displacement of other ocular prosthetic devices, implants and grafts, initial encounter |
| T86.8401 | Corneal transplant rejection, right eye |
| T86.8402 | Corneal transplant rejection, left eye |
| T86.8403 | Corneal transplant rejection, bilateral |
| T86.8411 | Corneal transplant failure, right eye |
| T86.8412 | Corneal transplant failure, left eye |
| T86.8413 | Corneal transplant failure, bilateral |
| Z94.7 | Corneal transplant status |
| Z98.41 | Cataract extraction status, right eye |
| Z98.42 | Cataract extraction status, left eye |
| Z98.83 | Filtering (vitreous) bleb after glaucoma surgery status |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 92025?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 76 ICD-10 diagnosis codes that support medical necessity for CPT 92025. The covered codes are listed on this page. Coverage varies by MAC/state — always confirm against the policy that applies to you.
What is a medical-necessity (LCD/NCD) crosswalk?
A claim whose procedure isn't supported by a covered diagnosis denies as "not medically necessary" (CARC 50). CMS coverage policies define which diagnoses justify a procedure; this page is the ICD-10 → CPT 92025 view of that relationship.
More free billing tools: all crosswalks · NCCI edits · Medicare fees · denial codes
Informational only, not coding, billing, or legal advice. Based on CMS Medicare Coverage Database data; verify the current LCD/NCD for your MAC before billing.
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