H40.9
BillableUnspecified glaucoma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H40.9 an HCC code?
No. H40.9 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 H40.9
For H40.9to 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 H40.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
H40.9 is the ICD-10-CM diagnosis code for unspecified glaucoma. Glaucoma where the specific type or cause has not been determined or documented. H40.9 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.9 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. Using this unspecified code captures the same RxHCC as more specific glaucoma codes, but best practice requires coding to the highest level of specificity supported by documentation. No hierarchies apply.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a default code; use only when the type of glaucoma cannot be determined from the record
- •Query the provider to obtain more specific glaucoma classification when possible
Clinical Significance
Unspecified glaucoma indicates a diagnosis of glaucoma without further specification of the type, stage, or laterality. While this code is valid, it represents the lowest specificity level and may indicate incomplete documentation. More specific coding improves clinical data quality and ensures accurate risk stratification for patient management.
Documentation Requirements
- ✓At minimum, a documented diagnosis of glaucoma by the treating provider
- ✓Intraocular pressure measurement
- ✓Optic nerve assessment
- ✓Query provider for specific type (open-angle, angle-closure, secondary) and laterality to enable more specific coding
- ✓If specific type cannot be determined, document the clinical reasoning
Commonly Confused Codes
- •H40.10-H40.14 — Primary open-angle glaucoma (most common type; code specifically when documented)
- •H40.20x — Angle-closure glaucoma subtypes (code specifically when documented)
- •H40.89 — Other specified glaucoma (use when a specific type is documented but has no dedicated code)
- •H40.001-H40.009 — Glaucoma suspect (use when glaucoma is suspected but not confirmed)