H40.049 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupH40.049

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Glaucoma (H40-H42)

H40.049

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Steroid responder, unspecified eye

A condition where eye pressure increases in response to steroid medication use, but the specific eye affected is not documented.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

H40.0Glaucoma suspect H40.04Steroid responder H40.049Steroid responder, unspecified eye

Inclusion Terms

Official

No inclusion terms are included in this display for H40.049. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59
neoplasms (C00-D49)Inherited from H00-H59
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59

Related Codes

Official

H40.041Steroid responder, right eye H40.042Steroid responder, left eye H40.043Steroid responder, bilateral

Includes

Official

No Includes notes are included in this display for H40.049. Check the code and parent instructions in the Code Book.

Excludes 1

Official

absolute glaucoma (H44.51-)Inherited from H40
congenital glaucoma (Q15.0)Inherited from H40
traumatic glaucoma due to birth injury (P15.3)Inherited from H40

Code First

Official

No Code First sequencing instructions are included in this display for H40.049. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H40.049. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H40.049. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Use this code only when laterality cannot be determined from documentation

Query the provider if possible to determine if one or both eyes are affected for more specific coding

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is H40.049 an HCC code?

No. H40.049 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H40.049
Description: Steroid responder, unspecified eye
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

H40.049 is the ICD-10-CM diagnosis code for steroid responder, unspecified eye. A condition where eye pressure increases in response to steroid medication use, but the specific eye affected is not documented. H40.049 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).

H40.049 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Use this code only when laterality cannot be determined from documentation.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H40.049 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 laterality cannot be determined from documentation
•Query the provider if possible to determine if one or both eyes are affected for more specific coding