H11.812
BillablePseudopterygium of conjunctiva, left eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H11.812 an HCC code?
No. H11.812 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
H11.812 is the ICD-10-CM diagnosis code for pseudopterygium of conjunctiva, left eye. A wing-like tissue growth on the conjunctiva of the left eye that resembles a pterygium but lacks certain characteristics of a true pterygium. H11.812 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of conjunctiva (h10-h11).
H11.812 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.
Confirm the diagnosis specifies pseudopterygium rather than true pterygium (H11.0).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H11.812 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm the diagnosis specifies pseudopterygium rather than true pterygium (H11.0)
- •Document laterality clearly to ensure correct code selection