H35.423 ICD-10-CM Code: Microcystoid degeneration of retina, bilateral
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H35.423
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMicrocystoid degeneration of retina, bilateral
This condition involves the development of tiny fluid-filled sacs in the retina (the light-sensitive tissue at the back of the eye) that affect both eyes. It is a degenerative eye condition that can impact vision over time.
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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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H35.423 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H35.423 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H35.423 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H35.423 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H35.423 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H35.423 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H35.423 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 H35.423 an HCC code?
No. H35.423 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
H35.423 is the ICD-10-CM diagnosis code for microcystoid degeneration of retina, bilateral. This condition involves the development of tiny fluid-filled sacs in the retina (the light-sensitive tissue at the back of the eye) that affect both eyes. It is a degenerative eye condition that can impact vision over time. H35.423 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).
H35.423 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 that the condition is documented as bilateral (affecting both eyes) before assigning this code; if only one eye is affected, use the unilateral code H35.421 instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H35.423 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the condition is documented as bilateral (affecting both eyes) before assigning this code; if only one eye is affected, use the unilateral code H35.421 instead
- •This code is typically used for chronic retinal conditions identified during ophthalmologic examination; ensure the documentation clearly describes microcystoid degeneration rather than other retinal cyst types