H40.89
BillableOther specified glaucoma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H40.89 an HCC code?
No. H40.89 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 H40.89
For H40.89to 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 H40.89 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
H40.89 is the ICD-10-CM diagnosis code for other specified glaucoma. Glaucoma that does not fit into other specific categories, such as unusual types or combinations of glaucoma conditions. H40.89 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.89 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.
Maps to RxHCC 244 (Glaucoma, Other) with a RAF weight of 0.000 in the prescription drug model. No mapping under CMS-HCC v28, v24, or ESRD models. The code's primary risk adjustment value is in the pharmacy model for predicting glaucoma-related medication costs. No hierarchies apply.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.89 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when the glaucoma type is documented but does not match other specific H40 codes
- •Include documentation of the specific glaucoma type in the medical record for clarity
Clinical Significance
Other specified glaucoma captures glaucoma types that do not fit into the more specific subcategories, such as traumatic glaucoma, glaucoma associated with eye anomalies, or other rare forms. This code serves as a catch-all for documented glaucoma types that have a specific clinical diagnosis but lack a dedicated ICD-10-CM code. Proper documentation of the specific type is essential.
Documentation Requirements
- ✓Specific type of glaucoma documented (e.g., traumatic, developmental, associated with specific eye anomaly)
- ✓Laterality documented when applicable (note: H40.89 does not have laterality extension)
- ✓Intraocular pressure measurement
- ✓Optic nerve evaluation and cup-to-disc ratio
- ✓Visual field testing results
- ✓Etiology or underlying cause documented
- ✓Current treatment plan
Commonly Confused Codes
- •H40.9 — Unspecified glaucoma (use H40.89 when the type IS specified but does not have its own code)
- •H40.10-H40.14 — Primary open-angle glaucoma (use when open-angle type is confirmed)
- •H40.20x — Primary angle-closure glaucoma subtypes (use when angle closure is confirmed)
- •H42 — Glaucoma in diseases classified elsewhere (use when glaucoma is due to a classified systemic disease)
- •H40.40-H40.43 — Glaucoma secondary to eye inflammation (use when uveitic glaucoma is the cause)