Question 1

What is ICD-10 code H33.111?

Accepted Answer

H33.111 is the ICD-10-CM diagnosis code for cyst of ora serrata, right eye. A fluid-filled sac or cavity located at the ora serrata (the junction between the retina and ciliary body) in the right eye. H33.111 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).

H33.111 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.

Ora serrata cysts are typically benign findings; ensure documentation specifies right eye to justify use of this code.

Question 2

Is H33.111 an HCC code?

Accepted Answer

No. H33.111 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 H33.111 billable?

Accepted Answer

Yes. H33.111 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. H33.111 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

What is the V28 vs V24 difference for H33.111?

Accepted Answer

H33.111 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 model rewards H33.111 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H33.111?

Accepted Answer

Ora serrata cysts are typically benign findings; ensure documentation specifies right eye to justify use of this code Distinguish between cysts of ora serrata and other retinal cysts, as they have different code assignments

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H33.111

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H33.111 ICD-10-CM Code: Cyst of ora serrata, right eye

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H33.111

Is H33.111 an HCC code?

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Work H33.111 in HCC Buddy