H43.811 ICD-10-CM Code: Vitreous degeneration, right eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of vitreous body and globe (H43-H44)
H43.811
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceVitreous degeneration, right eye
Deterioration or breakdown of the clear gel inside the right eye, which can lead to vision problems and floaters.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Vitreous detachment
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H43.811 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H43.811 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H43.811 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H43.811 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H43.811 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H43.811 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
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.
Coder workflow notes
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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