H40.152
BillableResidual stage of open-angle glaucoma, left eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H40.152 an HCC code?
No. H40.152 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 H40.152
For H40.152to 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 H40.152 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
H40.152 is the ICD-10-CM diagnosis code for residual stage of open-angle glaucoma, left eye. The final stage of open-angle glaucoma in the left eye, where significant vision loss has already occurred and the condition has stabilized. H40.152 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.152 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, H40.152 maps to RxHCC 243 (Glaucoma) with a RAF weight of 0.0. No V28, V24, or ESRD HCC mappings exist. The RxHCC mapping captures the ongoing need for glaucoma medications. The risk adjustment impact is primarily through medication cost predictions rather than direct RAF score contribution.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.152 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 left eye only
Clinical Significance
Residual stage of open-angle glaucoma in the left eye indicates controlled or arrested glaucomatous disease with permanent structural and functional damage in the left eye. Clinical management focuses on maintaining intraocular pressure control and monitoring for disease reactivation. The residual optic nerve and visual field damage may significantly impact the patient's quality of life and functional vision.
Documentation Requirements
- ✓History of open-angle glaucoma affecting the left eye with controlled disease
- ✓Current intraocular pressure measurement demonstrating control
- ✓Optic nerve documentation showing permanent cup-to-disc ratio changes
- ✓Visual field testing documenting residual field loss in the left eye
- ✓Medication list and treatment history for glaucoma management
Commonly Confused Codes
- •H40.151 — Residual stage of open-angle glaucoma, right eye: contralateral side
- •H40.1122 — Primary open-angle glaucoma, left eye, moderate stage: active disease process
- •H40.10X2 — Unspecified open-angle glaucoma, left eye: does not specify residual stage
- •H40.153 — Residual stage of open-angle glaucoma, bilateral: both eyes affected