Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 298 carries a community non-dual aged RAF of 0.336, and 180 payable ICD-10-CM diagnosis codes map to it.
RAF factors
The community factor varies by Medicaid and originally-disabled status; the institutional factor applies to long-term-institutional members. These are the CMS-HCC V28 PY2026 relative factors.
ICD-10-CM codes that map to HCC 298 (180)
Payable diagnosis codes that map to this category under CMS-HCC V28 PY2026. Open any code for its full description, HCC mapping, and coding guidance.
- E08.311Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema
- E08.3211Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye
- E08.3212Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye
- E08.3213Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral
- E08.3219Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E08.3311Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye
- E08.3312Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye
- E08.3313Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
- E08.3319Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E08.3411Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye
- E08.3412Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye
- E08.3413Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral
- E08.3419Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E08.3511Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye
- E08.3512Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye
- E08.3513Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral
- E08.3519Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye
- E08.3521Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
- E08.3522Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
- E08.3523Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
- E08.3529Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye
- E08.3531Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
- E08.3532Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
- E08.3533Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
- E08.3539Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye
- E08.3541Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
- E08.3542Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
- E08.3543Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
- E08.3549Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye
- E08.3551Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye
- E08.3552Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye
- E08.3553Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral
- E08.3559Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye
- E08.3591Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye
- E08.3592Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye
- E08.3593Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral
- E08.3599Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye
- E10.311Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema
- E10.3211Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
- E10.3212Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
- E10.3213Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
- E10.3219Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E10.3311Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
- E10.3312Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
- E10.3313Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
- E10.3319Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E10.3411Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
- E10.3412Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye
- E10.3413Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral
- E10.3419Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E10.3511Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
- E10.3512Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
- E10.3513Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
- E10.3519Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye
- E10.3521Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
- E10.3522Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
- E10.3523Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
- E10.3529Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye
- E10.3531Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
- E10.3532Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
- E10.3533Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
- E10.3539Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye
- E10.3541Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
- E10.3542Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
- E10.3543Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
- E10.3549Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye
- E10.3551Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye
- E10.3552Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye
- E10.3553Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
- E10.3559Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye
- E10.3591Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
- E10.3592Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
- E10.3593Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
- E10.3599Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
- E11.311Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
- E11.3211Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
- E11.3212Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
- E11.3213Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
- E11.3219Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E11.3311Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
- E11.3312Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
- E11.3313Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
- E11.3319Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E11.3411Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
- E11.3412Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye
- E11.3413Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral
- E11.3419Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E11.3511Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
- E11.3512Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
- E11.3513Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
- E11.3519Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye
- E11.3521Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
- E11.3522Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
- E11.3523Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
- E11.3529Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye
- E11.3531Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
- E11.3532Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
- E11.3533Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
- E11.3539Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye
- E11.3541Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
- E11.3542Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
- E11.3543Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
- E11.3549Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye
- E11.3551Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye
- E11.3552Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye
- E11.3553Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
- E11.3559Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye
- E11.3591Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
- E11.3592Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
- E11.3593Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
- E11.3599Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
- E13.311Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema
- E13.3211Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
- E13.3212Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
- E13.3213Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
- E13.3219Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E13.3311Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
- E13.3312Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
- E13.3313Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
- E13.3319Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E13.3411Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
- E13.3412Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye
- E13.3413Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral
- E13.3419Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye
- E13.3511Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
- E13.3512Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
- E13.3513Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
- E13.3519Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye
- E13.3521Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
- E13.3522Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
- E13.3523Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
- E13.3529Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye
- E13.3531Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
- E13.3532Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
- E13.3533Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
- E13.3539Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye
- E13.3541Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
- E13.3542Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
- E13.3543Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
- E13.3549Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye
- E13.3551Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye
- E13.3552Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye
- E13.3553Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
- E13.3559Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye
- E13.3591Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
- E13.3592Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
- E13.3593Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
- E13.3599Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
- H34.8110Central retinal vein occlusion, right eye, with macular edema
- H34.8111Central retinal vein occlusion, right eye, with retinal neovascularization
- H34.8112Central retinal vein occlusion, right eye, stable
- H34.8120Central retinal vein occlusion, left eye, with macular edema
- H34.8121Central retinal vein occlusion, left eye, with retinal neovascularization
- H34.8122Central retinal vein occlusion, left eye, stable
- H34.8130Central retinal vein occlusion, bilateral, with macular edema
- H34.8131Central retinal vein occlusion, bilateral, with retinal neovascularization
- H34.8132Central retinal vein occlusion, bilateral, stable
- H34.8190Central retinal vein occlusion, unspecified eye, with macular edema
- H34.8191Central retinal vein occlusion, unspecified eye, with retinal neovascularization
- H34.8192Central retinal vein occlusion, unspecified eye, stable
- H34.8310Tributary (branch) retinal vein occlusion, right eye, with macular edema
- H34.8311Tributary (branch) retinal vein occlusion, right eye, with retinal neovascularization
- H34.8312Tributary (branch) retinal vein occlusion, right eye, stable
- H34.8320Tributary (branch) retinal vein occlusion, left eye, with macular edema
- H34.8321Tributary (branch) retinal vein occlusion, left eye, with retinal neovascularization
- H34.8322Tributary (branch) retinal vein occlusion, left eye, stable
- H34.8330Tributary (branch) retinal vein occlusion, bilateral, with macular edema
- H34.8331Tributary (branch) retinal vein occlusion, bilateral, with retinal neovascularization
- H34.8332Tributary (branch) retinal vein occlusion, bilateral, stable
- H34.8390Tributary (branch) retinal vein occlusion, unspecified eye, with macular edema
- H34.8391Tributary (branch) retinal vein occlusion, unspecified eye, with retinal neovascularization
- H34.8392Tributary (branch) retinal vein occlusion, unspecified eye, stable
- H36.821Proliferative sickle-cell retinopathy, right eye
- H36.822Proliferative sickle-cell retinopathy, left eye
- H36.823Proliferative sickle-cell retinopathy, bilateral
- H36.829Proliferative sickle-cell retinopathy, unspecified eye
- H43.10Vitreous hemorrhage, unspecified eye
- H43.11Vitreous hemorrhage, right eye
- H43.12Vitreous hemorrhage, left eye
- H43.13Vitreous hemorrhage, bilateral
Frequently asked questions
What is CMS-HCC V28 category 298?
HCC 298 is "Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 180 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 298?
The community non-dual aged relative factor for CMS-HCC V28 category 298 is 0.336. The exact factor varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 Rate Announcement.
How many ICD-10-CM codes map to HCC 298?
180 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 298 (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage) for payment year 2026.
Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.