H43.811
BillableVitreous degeneration, right eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H43.811 an HCC code?
No. H43.811 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
H43.811 is the ICD-10-CM diagnosis code for vitreous degeneration, right eye. Deterioration or breakdown of the clear gel inside the right eye, which can lead to vision problems and floaters. H43.811 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).
H43.811 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.
Vitreous degeneration is often age-related; document patient age and any associated conditions (e.g., high myopia, retinal detachment).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H43.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Vitreous degeneration is often age-related; document patient age and any associated conditions (e.g., high myopia, retinal detachment)
- •Distinguish between primary degeneration and secondary degeneration due to other ocular pathology