H43.311
BillableVitreous membranes and strands, right eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H43.311 an HCC code?
No. H43.311 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H43.311 is the ICD-10-CM diagnosis code for vitreous membranes and strands, right eye. Thin membranes or string-like strands that form in the clear gel of the right eye, which may cause floaters or vision obstruction. H43.311 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of vitreous body and globe (h43-h44).
H43.311 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.
Ensure laterality is correctly documented as right eye only; bilateral cases require code H43.313.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H43.311 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure laterality is correctly documented as right eye only; bilateral cases require code H43.313
- •These membranes may be post-inflammatory, post-hemorrhagic, or idiopathic; document the etiology when available