H25.11
BillableAge-related nuclear cataract, right eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H25.11 an HCC code?
No. H25.11 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
H25.11 is the ICD-10-CM diagnosis code for age-related nuclear cataract, right eye. A clouding of the lens in the right eye that develops as part of the normal aging process, specifically affecting the central core (nucleus) of the lens. This condition causes progressive vision problems and is one of the most common types of cataracts in older adults. H25.11 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).
H25.11 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.
Always specify laterality (right eye, left eye, or bilateral) as H25.11 specifically indicates the right eye; use H25.12 for left eye and H25.13 for bilateral.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H25.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always specify laterality (right eye, left eye, or bilateral) as H25.11 specifically indicates the right eye; use H25.12 for left eye and H25.13 for bilateral
- •Verify the cataract type and stage documented by the ophthalmologist, as nuclear cataracts have different codes than cortical or posterior subcapsular cataracts