H30.013 ICD-10-CM Code: Focal chorioretinal inflammation, juxtapapillary, bilateral
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H30.013
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceFocal chorioretinal inflammation, juxtapapillary, bilateral
This is an inflammation of the choroid and retina (the light-sensitive layers at the back of the eye) that occurs on both sides of the eye, specifically in the area next to the optic nerve head. It causes localized swelling and irritation in this specific region of both eyes.
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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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H30.013 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H30.013 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H30.013 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H30.013 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H30.013 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H30.013 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H30.013 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 H30.013 an HCC code?
No. H30.013 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H30.013 is the ICD-10-CM diagnosis code for focal chorioretinal inflammation, juxtapapillary, bilateral. This is an inflammation of the choroid and retina (the light-sensitive layers at the back of the eye) that occurs on both sides of the eye, specifically in the area next to the optic nerve head. It causes localized swelling and irritation in this specific region of both eyes. H30.013 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of choroid and retina (h30-h36).
H30.013 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 that the inflammation is documented as bilateral (affecting both eyes) and juxtapapillary (near the optic disc) before assigning this code; if only one eye is affected, use the unilateral code instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H30.013 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the inflammation is documented as bilateral (affecting both eyes) and juxtapapillary (near the optic disc) before assigning this code; if only one eye is affected, use the unilateral code instead
- •This code is more specific than general chorioretinal inflammation codes, so ensure the clinical documentation clearly identifies the juxtapapillary location and bilateral nature to support accurate coding