H26.499 ICD-10-CM Code: Other secondary cataract, unspecified eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of lens (H25-H28)
H26.499
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther secondary cataract, unspecified eye
A clouding of the lens that develops after cataract surgery or other eye procedures, affecting an eye that is not specified as right or left. This type of cataract forms as a secondary complication rather than developing on its own.
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 H26.499 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H26.499 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H26.499 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H26.499 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H26.499 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H26.499 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H26.499 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 H26.499 an HCC code?
No. H26.499 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
H26.499 is the ICD-10-CM diagnosis code for other secondary cataract, unspecified eye. A clouding of the lens that develops after cataract surgery or other eye procedures, affecting an eye that is not specified as right or left. This type of cataract forms as a secondary complication rather than developing on its own. H26.499 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).
H26.499 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.
Use this code only when the specific eye (right or left) is not documented; if laterality is known, use H26.491 (right eye) or H26.492 (left eye) instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H26.499 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific eye (right or left) is not documented; if laterality is known, use H26.491 (right eye) or H26.492 (left eye) instead
- •Verify documentation indicates this is a secondary cataract (post-surgical or post-traumatic) rather than a primary age-related cataract, as this affects code selection