ICD-10 H49.812 is officially defined as "Kearns-Sayre syndrome, left eye." code H49.812 is referenced in 4 tracked payer policy changes from UnitedHealthcare. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H49.812 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
UnitedHealthcare's individual exchange botulinum toxin policy was revised effective November 1, 2026, which has already passed. The policy now applies in Massachusetts and New York, refers Nevada to the UnitedHealthcare Commercial version, and drops several diagnosis requirements for cervical dystonia, chronic anal fissures and detrusor overactivity, while HCPCS J0589 is now clarified for Daxxify and new eye-related ICD-10 codes were added for J0585 and J0586.
UnitedHealthcare and UMR updated the Botulinum Toxins A and B medical benefit drug policy, effective November 1, 2026, so the change is already in effect. It updates the list of ICD-10 diagnosis codes that apply to HCPCS codes J0585 and J0586 and adds a long run of eye diagnosis codes in the H49 and H50 series.
UnitedHealthcare Surest updated the approved ICD-10 diagnosis codes for botulinum toxin HCPCS codes J0585 and J0586, expanding coverage to include a comprehensive list of strabismus (H49.xx and H50.xx series) and ocular motility disorder codes. The policy also updated supporting clinical evidence and references. Effective November 1, 2026, billing teams must validate that botulinum toxin claims include only the newly approved diagnosis codes to avoid claim denials.
UnitedHealthcare updated its Botulinum Toxins A and B policy effective November 1, 2026, expanding the list of covered ICD-10 diagnosis codes for HCPCS codes J0585 and J0586. The update adds numerous eye muscle disorder codes (H49 and H50 series) and reflects current clinical evidence, FDA guidance, and CMS references. Billing teams must verify that claims for botulinum toxin injections include only the newly approved diagnosis codes to avoid denials.
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