H34.213
BillablePartial retinal artery occlusion, bilateral
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H34.213 an HCC code?
No. H34.213 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
H34.213 is the ICD-10-CM diagnosis code for partial retinal artery occlusion, bilateral. A condition where blood vessels in the retina (the light-sensitive tissue at the back of the eye) are partially blocked on both sides, reducing blood flow to the eye tissue. This can cause vision problems or vision loss if not treated promptly. H34.213 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).
H34.213 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 before assigning this code; unilateral cases require different codes (H34.211 for right eye, H34.212 for left eye).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H34.213 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies 'bilateral' involvement before assigning this code; unilateral cases require different codes (H34.211 for right eye, H34.212 for left eye)
- •Ensure the retinal artery occlusion is documented as 'partial' rather than 'complete' or 'central' as these have distinct code assignments