H34.12
BillableCentral retinal artery occlusion, left eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H34.12 an HCC code?
No. H34.12 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
H34.12 is the ICD-10-CM diagnosis code for central retinal artery occlusion, left eye. A blockage of the main artery that supplies blood to the retina in the left eye, which can cause sudden vision loss. H34.12 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).
H34.12 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.
This is a laterality-specific code; ensure documentation clearly indicates left eye involvement.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H34.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a laterality-specific code; ensure documentation clearly indicates left eye involvement
- •Central retinal artery occlusion is often an ophthalmologic emergency requiring immediate treatment to prevent permanent vision loss