H33.192 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupH33.192

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)

H33.192

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other retinoschisis and retinal cysts, left eye

A condition where the retina (the light-sensitive tissue at the back of the eye) splits into layers or develops fluid-filled pockets in the left eye.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

H33.1Retinoschisis and retinal cysts H33.19Other retinoschisis and retinal cysts H33.192Other retinoschisis and retinal cysts, left eye

Inclusion Terms

Official

Pseudocyst of retinaInherited from H33.19

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59
neoplasms (C00-D49)Inherited from H00-H59
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59

Related Codes

Official

H33.191Other retinoschisis and retinal cysts, right eye H33.193Other retinoschisis and retinal cysts, bilateral H33.199Other retinoschisis and retinal cysts, unspecified eye

Includes

Official

No Includes notes are included in this display for H33.192. Check the code and parent instructions in the Code Book.

Excludes 1

Official

detachment of retinal pigment epithelium (H35.72-, H35.73-)Inherited from H33, H33.1
congenital retinoschisis (Q14.1)Inherited from H33, H33.1
microcystoid degeneration of retina (H35.42-)Inherited from H33, H33.1

Code First

Official

No Code First sequencing instructions are included in this display for H33.192. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H33.192. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H33.192. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Verify laterality is documented as left eye to ensure accurate code selection

Distinguish between retinoschisis (layer splitting) and retinal cysts (fluid pockets) in clinical documentation

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is H33.192 an HCC code?

No. H33.192 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H33.192
Description: Other retinoschisis and retinal cysts, left eye
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

H33.192 is the ICD-10-CM diagnosis code for other retinoschisis and retinal cysts, left eye. A condition where the retina (the light-sensitive tissue at the back of the eye) splits into layers or develops fluid-filled pockets in the left eye. H33.192 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).

H33.192 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Verify laterality is documented as left eye to ensure accurate code selection.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H33.192 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify laterality is documented as left eye to ensure accurate code selection
•Distinguish between retinoschisis (layer splitting) and retinal cysts (fluid pockets) in clinical documentation