H26.031 ICD-10-CM Code: Infantile and juvenile nuclear cataract, right eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of lens (H25-H28)
H26.031
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceInfantile and juvenile nuclear cataract, right eye
A clouding of the lens in the center (nucleus) of the right eye that develops in infants or children, affecting vision by making it blurry or dim. This type of cataract is present from birth or develops early in childhood.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H26.031 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H26.031 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H26.031 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H26.031 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H26.031 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H26.031 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H26.031 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H26.031 an HCC code?
No. H26.031 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
H26.031 is the ICD-10-CM diagnosis code for infantile and juvenile nuclear cataract, right eye. A clouding of the lens in the center (nucleus) of the right eye that develops in infants or children, affecting vision by making it blurry or dim. This type of cataract is present from birth or develops early in childhood. H26.031 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).
H26.031 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 the laterality is specifically documented as right eye (not left or bilateral) before assigning this code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H26.031 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the laterality is specifically documented as right eye (not left or bilateral) before assigning this code
- •Confirm the cataract type is nuclear and the patient age is infantile or juvenile; if the cataract is congenital, consider using the congenital cataract codes (Q12.0x) instead