H40.151
BillableResidual stage of open-angle glaucoma, right eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H40.151 an HCC code?
No. H40.151 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for H40.151
For H40.151to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed H40.151 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
H40.151 is the ICD-10-CM diagnosis code for residual stage of open-angle glaucoma, right eye. The final stage of open-angle glaucoma in the right eye, where significant vision loss has already occurred and the condition has stabilized. H40.151 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.151 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.
In the RxHCC model, H40.151 maps to RxHCC 243 (Glaucoma) with a RAF weight of 0.0. This code does not map to V28, V24, or ESRD HCCs. The RxHCC mapping reflects ongoing medication management needs for glaucoma. The primary risk adjustment impact is through the RxHCC model's recognition of chronic ophthalmic medication use.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.151 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 documentation confirms the residual stage, not earlier stages of open-angle glaucoma
- •Ensure laterality is clearly documented; this code is specific to the right eye only
Clinical Significance
Residual stage of open-angle glaucoma in the right eye indicates that the glaucomatous disease process has been controlled or arrested but residual optic nerve damage and visual field loss persist. This stage reflects the permanent nature of glaucoma damage — while intraocular pressure may be normalized through treatment, the structural and functional damage remains. Ongoing monitoring is required to detect any reactivation of the disease process.
Documentation Requirements
- ✓Documented history of open-angle glaucoma in the right eye with current residual damage
- ✓Intraocular pressure measurements showing current control
- ✓Optic nerve assessment documenting permanent cupping or damage
- ✓Visual field testing showing residual field loss
- ✓Current treatment regimen (medications, prior surgical interventions) and monitoring plan
Commonly Confused Codes
- •H40.1111 — Primary open-angle glaucoma, right eye, mild stage: active disease, not residual
- •H40.152 — Residual stage of open-angle glaucoma, left eye: contralateral side
- •H40.10X1 — Unspecified open-angle glaucoma, right eye: does not specify the residual stage
- •H40.159 — Residual stage of open-angle glaucoma, unspecified eye: less specific laterality