Question 1

What is ICD-10 code H26.229?

Accepted Answer

H26.229 is the ICD-10-CM diagnosis code for cataract secondary to ocular disorders (degenerative) (inflammatory), unspecified eye. Clouding of the lens in an unspecified eye that develops as a secondary effect from other eye diseases that cause degeneration or inflammation. H26.229 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).

H26.229 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.

This code should only be used when the specific eye affected is not documented in the medical record.

Question 2

Is H26.229 an HCC code?

Accepted Answer

No. H26.229 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H26.229 billable?

Accepted Answer

Yes. H26.229 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. H26.229 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 H26.229 map to under V28?

Accepted Answer

H26.229 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does H26.229 pay in RAF?

Accepted Answer

H26.229 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for H26.229?

Accepted Answer

H26.229 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards H26.229 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports H26.229?

Accepted Answer

This code should only be used when the specific eye affected is not documented in the medical record Request clarification from the provider regarding which eye is affected to assign a more specific code H26.229 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

HCC Buddy Code Card

H26.229

Is H26.229 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H26.229 in HCC Buddy

H26.229 ICD-10-CM Code: Cataract secondary to ocular disorders (degenerative) (inflammatory), unspecified eye

HCC Buddy Code Card

H26.229

Is H26.229 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H26.229 in HCC Buddy