H40.011
BillableOpen angle with borderline findings, low risk, right eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H40.011 an HCC code?
No. H40.011 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
H40.011 is the ICD-10-CM diagnosis code for open angle with borderline findings, low risk, right eye. This code describes a patient with open-angle glaucoma in the right eye who has borderline eye pressure and structural findings but is considered at low risk for vision loss. The eye drainage system is open, but there are early warning signs that need monitoring. H40.011 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.011 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 code requires documentation of the specific eye affected (right eye in this case) and confirmation of borderline findings with low-risk classification by the ophthalmologist.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.011 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code requires documentation of the specific eye affected (right eye in this case) and confirmation of borderline findings with low-risk classification by the ophthalmologist
- •Ensure the provider documents the basis for 'low risk' determination, which typically includes intraocular pressure measurements, optic nerve appearance, and visual field results