Question 1

What is ICD-10 code H25.043?

Accepted Answer

H25.043 is the ICD-10-CM diagnosis code for posterior subcapsular polar age-related cataract, bilateral. A clouding of the lens affecting both eyes that develops with age, specifically affecting the back outer layer of the lens in a polar pattern. H25.043 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).

H25.043 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.

Use this code only when documentation clearly indicates bilateral involvement.

Question 2

Is H25.043 an HCC code?

Accepted Answer

H25.043 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 3

Is H25.043 billable?

Accepted Answer

Yes. H25.043 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. H25.043 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 H25.043 map to under V28?

Accepted Answer

H25.043 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 5

What RAF reference is published for H25.043?

Accepted Answer

H25.043 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 H25.043?

Accepted Answer

H25.043 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 H25.043?

Accepted Answer

Use this code only when documentation clearly indicates bilateral involvement Report this code once per encounter even though it represents both eyes H25.043 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 H25.043 be a primary diagnosis?

Accepted Answer

Yes. H25.043 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 H25.043?

Accepted Answer

No Excludes1 note applies to H25.043 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 H25.043 when both are documented.

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H25.043

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H25.043 ICD-10-CM Code: Posterior subcapsular polar age-related cataract, bilateral

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H25.043

Is H25.043 an HCC code?

Get the V28 mapping + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Also searched as

Work H25.043 in HCC Buddy