Question 1

What is ICD-10 code H40.003?

Accepted Answer

H40.003 is the ICD-10-CM diagnosis code for Preglaucoma, unspecified, bilateral. It belongs to the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59). H40.003 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H40.003 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Question 2

Is H40.003 an HCC code?

Accepted Answer

No. H40.003 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H40.003 billable?

Accepted Answer

Yes. H40.003 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H40.003 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

Which HCC does H40.003 map to under V28?

Accepted Answer

H40.003 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does H40.003 pay in RAF?

Accepted Answer

H40.003 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for H40.003?

Accepted Answer

H40.003 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards H40.003 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports H40.003?

Accepted Answer

Verify that the documentation confirms bilateral (both eyes) involvement before assigning this code; if only one eye is affected, use the unilateral code H40.001 or H40.002 instead This is a preglaucoma code, not actual glaucoma; ensure the provider has documented early warning signs or risk factors rather than confirmed glaucoma diagnosis, and review for any more specific preglaucoma subtypes that might apply H40.003 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

HCC Buddy Code Card

H40.003

Is H40.003 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H40.003 in HCC Buddy

H40.003 ICD-10-CM Code: Preglaucoma, unspecified, bilateral

HCC Buddy Code Card

H40.003

Is H40.003 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H40.003 in HCC Buddy