H43.319
BillableVitreous membranes and strands, unspecified eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H43.319 an HCC code?
No. H43.319 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
H43.319 is the ICD-10-CM diagnosis code for vitreous membranes and strands, unspecified eye. Thin membranes or string-like strands in the clear gel of the eye when the specific eye is not documented or specified. H43.319 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).
H43.319 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.
This is a default code used only when laterality cannot be determined; always attempt to clarify which eye(s) are affected.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H43.319 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 used only when laterality cannot be determined; always attempt to clarify which eye(s) are affected
- •Query the provider if documentation is ambiguous regarding unilateral versus bilateral involvement