H35.20 ICD-10-CM Code: Other non-diabetic proliferative retinopathy, unspecified eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H35.20
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther non-diabetic proliferative retinopathy, unspecified eye
This code describes abnormal blood vessel growth in the retina (the light-sensitive tissue at the back of the eye) that is not caused by diabetes. This condition can lead to vision problems if the new blood vessels bleed or cause scarring.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
Official- Proliferative vitreo-retinopathy
- Thalassemia proliferative retinopathy
Excludes 2
Official- proliferative sickle-cell retinopathy (H36.82-)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H35.20 in this effective period.
Excludes 1
Official- proliferative vitreo-retinopathy with retinal detachment (H33.4-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H35.20 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H35.20 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H35.20 in this effective period.
Buddy Documentation Tip
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.
Is H35.20 an HCC code?
No. H35.20 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
H35.20 is the ICD-10-CM diagnosis code for other non-diabetic proliferative retinopathy, unspecified eye. This code describes abnormal blood vessel growth in the retina (the light-sensitive tissue at the back of the eye) that is not caused by diabetes. This condition can lead to vision problems if the new blood vessels bleed or cause scarring. H35.20 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).
H35.20 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 the eye laterality - if documentation specifies right eye (H35.21), left eye (H35.22), or bilateral (H35.23), use the more specific code instead of the unspecified code H35.20.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H35.20 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the eye laterality - if documentation specifies right eye (H35.21), left eye (H35.22), or bilateral (H35.23), use the more specific code instead of the unspecified code H35.20
- •Confirm the retinopathy is non-diabetic by reviewing the medical record; if diabetes is present, use diabetic retinopathy codes (E11.3x-E13.3x) instead