Question 1

What is ICD-10 code H21.302?

Accepted Answer

H21.302 is the ICD-10-CM diagnosis code for idiopathic cysts of iris, ciliary body or anterior chamber, left eye. Fluid-filled cysts in the iris, ciliary body, or front chamber of the left eye that develop without a known cause. H21.302 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).

H21.302 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.

Verify left eye laterality in documentation to ensure correct code selection.

Question 2

Is H21.302 an HCC code?

Accepted Answer

No. H21.302 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H21.302 billable?

Accepted Answer

Yes. H21.302 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H21.302 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for H21.302?

Accepted Answer

H21.302 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards H21.302 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H21.302?

Accepted Answer

Verify left eye laterality in documentation to ensure correct code selection Distinguish idiopathic cysts from those secondary to inflammation, trauma, or other ocular conditions

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H21.302

Is H21.302 an HCC code?

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Open H21.302 in the Interactive Encoder

H21.302 ICD-10-CM Code: Idiopathic cysts of iris, ciliary body or anterior chamber, left eye

HCC Buddy Code Card

H21.302

Is H21.302 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H21.302 in the Interactive Encoder