H35.53 ICD-10-CM Code: Other dystrophies primarily involving the sensory retina
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H35.53
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther dystrophies primarily involving the sensory retina
A hereditary condition causing progressive degeneration of the light-sensitive cells and supporting structures of the retina, excluding conditions primarily affecting the pigment layer.
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
Code Trumping
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Code Book Path
Inclusion Terms
Official- Stargardt's disease
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H35.53 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H35.53 in this effective period.
Excludes 1
Official- dystrophies primarily involving Bruch's membrane (H31.1-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H35.53 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H35.53 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H35.53 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 H35.53 an HCC code?
No. H35.53 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H35.53 is the ICD-10-CM diagnosis code for other dystrophies primarily involving the sensory retina. A hereditary condition causing progressive degeneration of the light-sensitive cells and supporting structures of the retina, excluding conditions primarily affecting the pigment layer. H35.53 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).
H35.53 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.
This is a catch-all code for retinal dystrophies affecting the sensory retina that don't fit other specific categories.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H35.53 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a catch-all code for retinal dystrophies affecting the sensory retina that don't fit other specific categories
- •Ensure the condition is not primarily affecting the retinal pigment epithelium, which would require code H35.54