H35.101 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupH35.101

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)

H35.101

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

Retinopathy of prematurity, unspecified, right eye

A condition affecting premature infants where blood vessels in the retina don't develop normally, affecting the right eye only, with severity not yet specified.

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

H35.1Retinopathy of prematurity H35.10Retinopathy of prematurity, unspecified H35.101Retinopathy of prematurity, unspecified, right eye

Inclusion Terms

Official

Retinopathy of prematurity NOSInherited from H35.10

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59, H35
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59, H35
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59, H35
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59, H35
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59, H35
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59, H35
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59, H35
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59, H35
neoplasms (C00-D49)Inherited from H00-H59, H35
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59, H35
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59, H35
diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)Inherited from H00-H59, H35

Related Codes

Official

H35.102Retinopathy of prematurity, unspecified, left eye H35.103Retinopathy of prematurity, unspecified, bilateral H35.109Retinopathy of prematurity, unspecified, unspecified eye

Includes

Official

No Includes notes are included in this display for H35.101. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for H35.101. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for H35.101. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H35.101. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H35.101. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

This code is used when retinopathy of prematurity is diagnosed but the stage has not been determined or documented.

Always verify the laterality (right, left, bilateral, or unspecified) as this affects code selection and must match 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 H35.101 an HCC code?

No. H35.101 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: H35.101
Description: Retinopathy of prematurity, unspecified, right 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

H35.101 is the ICD-10-CM diagnosis code for retinopathy of prematurity, unspecified, right eye. A condition affecting premature infants where blood vessels in the retina don't develop normally, affecting the right eye only, with severity not yet specified. H35.101 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).

H35.101 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.

This code is used when retinopathy of prematurity is diagnosed but the stage has not been determined or documented.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H35.101 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code is used when retinopathy of prematurity is diagnosed but the stage has not been determined or documented.
•Always verify the laterality (right, left, bilateral, or unspecified) as this affects code selection and must match clinical documentation.