Question 1

What is ICD-10 code H40.053?

Accepted Answer

H40.053 is the ICD-10-CM diagnosis code for ocular hypertension, bilateral. Elevated eye pressure in both eyes without the structural damage characteristic of glaucoma. H40.053 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).

H40.053 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.

Verify bilateral involvement is explicitly documented before assigning this code.

Question 2

Is H40.053 an HCC code?

Accepted Answer

No. H40.053 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 H40.053 billable?

Accepted Answer

Yes. H40.053 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. H40.053 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

What is the V28 vs V24 difference for H40.053?

Accepted Answer

H40.053 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 model rewards H40.053 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H40.053?

Accepted Answer

Verify bilateral involvement is explicitly documented before assigning this code Consider investigating underlying causes such as steroid use, elevated episcleral venous pressure, or other risk factors

HCC Buddy Code Card

H40.053

Is H40.053 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H40.053 in HCC Buddy

H40.053 ICD-10-CM Code: Ocular hypertension, bilateral

HCC Buddy Code Card

H40.053

Is H40.053 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H40.053 in HCC Buddy