H00.031
BillableAbscess of right upper eyelid
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H00.031 an HCC code?
No. H00.031 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H00.031 is the ICD-10-CM diagnosis code for abscess of right upper eyelid. A collection of pus or localized infection in the tissues of the right upper eyelid, representing a more serious infection than a simple hordeolum. H00.031 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of eyelid, lacrimal system and orbit (h00-h05).
H00.031 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Abscess codes indicate a more severe infection with purulent material; ensure this diagnosis is clearly documented.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H00.031 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Abscess codes indicate a more severe infection with purulent material; ensure this diagnosis is clearly documented
- •Confirm right eye and upper eyelid location are specified; abscess may require drainage or more aggressive treatment