H40.153
BillableResidual stage of open-angle glaucoma, bilateral
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H40.153 an HCC code?
No. H40.153 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 H40.153
For H40.153to 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 H40.153 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
H40.153 is the ICD-10-CM diagnosis code for residual stage of open-angle glaucoma, bilateral. This code describes a late-stage condition where both eyes have open-angle glaucoma that has progressed to the residual stage, meaning significant vision loss has already occurred and the eye pressure damage is now stabilized or minimal. The residual stage indicates the patient has already experienced substantial optic nerve damage from the disease. H40.153 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.153 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, H40.153 maps to RxHCC 243 (Glaucoma) with a RAF weight of 0.0. No V28, V24, or ESRD HCC mappings exist. Bilateral disease does not carry additional HCC weight compared to unilateral, but it reflects greater clinical severity and functional impact. The RxHCC mapping captures medication management costs.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.153 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies 'bilateral' (both eyes) and 'residual stage' before assigning this code; if only one eye is affected, use the unilateral code (H40.151) instead
- •Ensure the glaucoma type is confirmed as 'open-angle' in the medical record, as this distinguishes it from other glaucoma types like angle-closure or secondary glaucoma
Clinical Significance
Residual stage of open-angle glaucoma, bilateral indicates that both eyes have arrested glaucoma with permanent residual damage. Bilateral residual glaucoma carries greater functional impact than unilateral disease, as both eyes have sustained irreversible optic nerve and visual field damage. These patients require ongoing bilateral monitoring and may have more significant visual disability affecting daily functioning.
Documentation Requirements
- ✓Bilateral ophthalmic examination documenting residual glaucoma damage in both eyes
- ✓Intraocular pressure measurements for both eyes showing current control
- ✓Optic nerve assessment of both eyes with documented permanent damage
- ✓Bilateral visual field testing showing residual field loss
- ✓Complete medication and surgical treatment history for both eyes
Commonly Confused Codes
- •H40.151/H40.152 — Residual stage of open-angle glaucoma, right/left eye: use when only one eye has residual disease
- •H40.1130/H40.1131 — Primary open-angle glaucoma, bilateral, various stages: active disease stages
- •H40.159 — Residual stage of open-angle glaucoma, unspecified eye: less specific, use only when laterality unknown
- •H40.10X3 — Unspecified open-angle glaucoma, bilateral: does not specify residual stage