H35.469
BillableSecondary vitreoretinal degeneration, unspecified eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H35.469 an HCC code?
No. H35.469 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
H35.469 is the ICD-10-CM diagnosis code for secondary vitreoretinal degeneration, unspecified eye. Deterioration of the light-sensitive tissue at the back of the eye (retina) and the gel-like substance filling the eye (vitreous) that has developed as a result of another eye condition or disease, but the specific eye affected is not documented. H35.469 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).
H35.469 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.
Use this code only when the eye affected (right, left, or bilateral) is not specified in the medical record.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H35.469 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the eye affected (right, left, or bilateral) is not specified in the medical record
- •Query the provider if possible to determine laterality for more specific coding