Paralytic strabismus (H49) ICD-10-CM
The H49 code range covers paralytic strabismus with 38 ICD-10-CM diagnosis codes. 29 of them are billable and valid for claim submission in fiscal year 2027, and the category headers group them but cannot themselves be billed.
Type 2 Excludes
A type 2 excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
Codes in the H49 Range 38 codes · 29 billable
- H49 Paralytic strabismusNon-billable
- H49.0 Third [oculomotor] nerve palsyNon-billable
- H49.00 Third [oculomotor] nerve palsy, unspecified eye
- H49.01 Third [oculomotor] nerve palsy, right eye
- H49.02 Third [oculomotor] nerve palsy, left eye
- H49.03 Third [oculomotor] nerve palsy, bilateral
- H49.1 Fourth [trochlear] nerve palsyNon-billable
- H49.10 Fourth [trochlear] nerve palsy, unspecified eye
- H49.11 Fourth [trochlear] nerve palsy, right eye
- H49.12 Fourth [trochlear] nerve palsy, left eye
- H49.13 Fourth [trochlear] nerve palsy, bilateral
- H49.2 Sixth [abducent] nerve palsyNon-billable
- H49.20 Sixth [abducent] nerve palsy, unspecified eye
- H49.21 Sixth [abducent] nerve palsy, right eye
- H49.22 Sixth [abducent] nerve palsy, left eye
- H49.23 Sixth [abducent] nerve palsy, bilateral
- H49.3 Total (external) ophthalmoplegiaNon-billable
- H49.30 Total (external) ophthalmoplegia, unspecified eye
- H49.31 Total (external) ophthalmoplegia, right eye
- H49.32 Total (external) ophthalmoplegia, left eye
- H49.33 Total (external) ophthalmoplegia, bilateral
- H49.4 Progressive external ophthalmoplegiaNon-billable
- H49.40 Progressive external ophthalmoplegia, unspecified eye
- H49.41 Progressive external ophthalmoplegia, right eye
- H49.42 Progressive external ophthalmoplegia, left eye
- H49.43 Progressive external ophthalmoplegia, bilateral
- H49.8 Other paralytic strabismusNon-billable
- H49.81 Kearns-Sayre syndromeNon-billable
- H49.811 Kearns-Sayre syndrome, right eye
- H49.812 Kearns-Sayre syndrome, left eye
- H49.813 Kearns-Sayre syndrome, bilateral
- H49.819 Kearns-Sayre syndrome, unspecified eye
- H49.88 Other paralytic strabismusNon-billable
- H49.881 Other paralytic strabismus, right eye
- H49.882 Other paralytic strabismus, left eye
- H49.883 Other paralytic strabismus, bilateral
- H49.889 Other paralytic strabismus, unspecified eye
- H49.9 Unspecified paralytic strabismus
Clinical Terms in This Code Range
Definitions from the National Library of Medicine for conditions coded in the H49 range.
Kearns-Sayre Syndrome
A mitochondrial disorder featuring the triad of chronic progressive EXTERNAL OPHTHALMOPLEGIA, cardiomyopathy (CARDIOMYOPATHIES) with conduction block (HEART BLOCK), and RETINITIS PIGMENTOSA. Disease onset is in the first or second decade. Elevated CSF protein, sensorineural deafness, seizures, and pyramidal signs may also be present. Ragged-red fibers are found on muscle biopsy. (Adams et al., Principles of Neurology, 6th ed, p984)
Ophthalmoplegia, Chronic Progressive External
A mitochondrial myopathy characterized by slowly progressive paralysis of the levator palpebrae, orbicularis oculi, and extraocular muscles. Ragged-red fibers and atrophy are found on muscle biopsy. Familial and sporadic forms may occur. Disease onset is usually in the first or second decade of life, and the illness slowly progresses until usually all ocular motility is lost. (From Adams et al., Principles of Neurology, 6th ed, p1422)
About the H49 Code Range
Paralytic strabismus includes conditions named for nerve palsy, or paralysis, and external ophthalmoplegia, a form of eye movement paralysis.
The subdivisions distinguish third nerve palsy (H49.0), fourth nerve palsy (H49.1), and sixth nerve palsy (H49.2). They also distinguish total external ophthalmoplegia (H49.3) from progressive external ophthalmoplegia (H49.4). Other paralytic strabismus includes Kearns-Sayre syndrome and a separate group for other forms. These subdivisions distinguish the right eye, left eye, both eyes, or an unspecified eye. H49.9 identifies unspecified paralytic strabismus.
Questions About This Page
How many billable codes are in the H49 range?
Of the 38 codes in this range, 29 are billable and valid for claim submission from October 1, 2026 through September 30, 2027. Category header codes group them but cannot be reported on claims.
What does the H49 range classify?
The range classifies paralytic strabismus. Each code links to its own reference page with billing status, MS-DRG grouping, coding notes, and clinical information.
Related References
Source: CMS FY 2027 ICD-10-CM Tabular List and order file, effective October 1, 2026 through September 30, 2027.
