Question 1

What is ICD-10 code H30.113?

Accepted Answer

H30.113 is the ICD-10-CM diagnosis code for disseminated chorioretinal inflammation of posterior pole, bilateral. Inflammation affecting the choroid and retina (the light-sensitive layers at the back of the eye) spread across the posterior pole (back central area) in both eyes. H30.113 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).

H30.113 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 documentation specifies bilateral involvement; if only one eye is affected, use H30.111 or H30.112 instead.

Question 2

Is H30.113 an HCC code?

Accepted Answer

No. H30.113 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 H30.113 billable?

Accepted Answer

Yes. H30.113 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. H30.113 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 H30.113 map to under V28?

Accepted Answer

H30.113 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 H30.113 pay in RAF?

Accepted Answer

H30.113 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 H30.113?

Accepted Answer

H30.113 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 H30.113 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 H30.113?

Accepted Answer

Verify documentation specifies bilateral involvement; if only one eye is affected, use H30.111 or H30.112 instead Confirm the inflammation is disseminated (widespread) and located in the posterior pole region to distinguish from peripheral or generalized patterns H30.113 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.

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H30.113

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H30.113 ICD-10-CM Code: Disseminated chorioretinal inflammation of posterior pole, bilateral

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H30.113

Is H30.113 an HCC code?

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