Question 1

What is ICD-10 code H25.011?

Accepted Answer

H25.011 is the ICD-10-CM diagnosis code for cortical age-related cataract, right eye. Age-related clouding of the lens in the right eye that starts in the outer layer of the lens, typically occurring in older adults. H25.011 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of lens (h25-h28).

H25.011 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Specify laterality (right, left, bilateral, or unspecified) as required by the fifth character.

Question 2

Is H25.011 an HCC code?

Accepted Answer

H25.011 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 3

Is H25.011 billable?

Accepted Answer

Yes. H25.011 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. H25.011 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

Which HCC does H25.011 map to under V28?

Accepted Answer

H25.011 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 5

What RAF reference is published for H25.011?

Accepted Answer

H25.011 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

Question 6

What is the V28 vs V24 difference for H25.011?

Accepted Answer

H25.011 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

Question 7

What documentation supports H25.011?

Accepted Answer

Specify laterality (right, left, bilateral, or unspecified) as required by the fifth character Cortical cataracts are the most common type of age-related cataract; document which eye is affected for accurate coding H25.011 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

Question 8

Can H25.011 be a primary diagnosis?

Accepted Answer

Yes. H25.011 carries no code-first instruction in the FY2026 tabular, so it can be the first-listed diagnosis when it is the condition chiefly responsible for the encounter and the note supports it, and it can also be reported as a secondary diagnosis. For risk adjustment the order does not matter; the V28 category is the same either way.

Question 9

Which codes cannot be reported with H25.011?

Accepted Answer

No Excludes1 note applies to H25.011 or its category in the FY2026 tabular, so there is no code the classification forbids alongside it. The Excludes2 note lists certain conditions originating in the perinatal period (P04-P96); certain infectious and parasitic diseases (A00-B99); complications of pregnancy, childbirth and the puerperium (O00-O9A); congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99); and 8 more (see the notes on this page); those are separate conditions that may be reported together with H25.011 when both are documented.

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H25.011

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H25.011 ICD-10-CM Code: Cortical age-related cataract, right eye

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H25.011

Is H25.011 an HCC code?

Get the V28 mapping + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Also searched as

Work H25.011 in HCC Buddy