H25.042 ICD-10-CM Code: Posterior subcapsular polar age-related cataract, left eye
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of lens (H25-H28)
H25.042
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePosterior subcapsular polar age-related cataract, left eye
A clouding of the lens in the left eye that develops with age, specifically affecting the back outer layer of the lens in a polar pattern.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H25.042 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H25.042 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H25.042 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H25.042 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H25.042 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H25.042 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H25.042 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is H25.042 an HCC code?
No. H25.042 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- H25.042
- Description
- Posterior subcapsular polar age-related cataract, left eye
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H25.042 is the ICD-10-CM diagnosis code for posterior subcapsular polar age-related cataract, left eye. A clouding of the lens in the left eye that develops with age, specifically affecting the back outer layer of the lens in a polar pattern. H25.042 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).
H25.042 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 laterality is documented as left eye in the medical record before assigning this code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H25.042 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify laterality is documented as left eye in the medical record before assigning this code
- •This is a subcategory of age-related cataracts; ensure the cataract type and location are clearly documented