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

H35.11

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Retinopathy of prematurity, stage 0

Retinopathy of prematurity, stage 0

CMS-HCC V28

0

0

RAF 0

CMS-HCC V24

0

0

RAF 0

ACA/HHS

0

0

RAF 0

ESRD/PACE

0

0

RAF 0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
H35Other retinal disorders
H35.1Retinopathy of prematurity
H35.11Retinopathy of prematurity, stage 0

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H35.11 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H35.11 in this effective period.

Related Child Codes

Official
H35.111Retinopathy of prematurity, stage 0, right eye
H35.112Retinopathy of prematurity, stage 0, left eye
H35.113Retinopathy of prematurity, stage 0, bilateral
H35.119Retinopathy of prematurity, stage 0, unspecified eye

Includes

Official

ICD-10-CM does not list Includes notes for H35.11 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H35.11 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H35.11 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H35.11 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H35.11 in this effective period.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

What This Code Means

H35.11 is the ICD-10-CM diagnosis code for retinopathy of prematurity, stage 0. H35.11 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).

Header codes like H35.11 cannot be reported on claims directly — they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at H35.11's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H35.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Child Codes

Code Hierarchy

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