H21.222 ICD-10-CM Code: Degeneration of ciliary body, left eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of sclera, cornea, iris and ciliary body (H15-H22)
H21.222
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceDegeneration of ciliary body, left eye
This code describes a condition where the ciliary body (a part of the eye that helps control focus and produces fluid) is deteriorating or breaking down in the left eye. This degeneration can affect the eye's ability to focus properly and maintain normal eye pressure.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H21.222 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H21.222 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H21.222 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H21.222 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H21.222 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H21.222 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H21.222 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H21.222 an HCC code?
No. H21.222 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
H21.222 is the ICD-10-CM diagnosis code for degeneration of ciliary body, left eye. This code describes a condition where the ciliary body (a part of the eye that helps control focus and produces fluid) is deteriorating or breaking down in the left eye. This degeneration can affect the eye's ability to focus properly and maintain normal eye pressure. H21.222 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of sclera, cornea, iris and ciliary body (h15-h22).
H21.222 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.
Ensure documentation specifies 'left eye' to justify the laterality code '2' in the fifth character; if both eyes are affected, code each eye separately with appropriate laterality indicators.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H21.222 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation specifies 'left eye' to justify the laterality code '2' in the fifth character; if both eyes are affected, code each eye separately with appropriate laterality indicators
- •Verify that the degeneration is not secondary to another condition (such as trauma, inflammation, or surgery); if it is, consider coding the underlying cause as the primary diagnosis