H43.813
BillableVitreous degeneration, bilateral
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H43.813 an HCC code?
No. H43.813 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
H43.813 is the ICD-10-CM diagnosis code for vitreous degeneration, bilateral. Deterioration or breakdown of the clear gel (vitreous) that fills both eyes. This can cause floaters or blurred vision in both eyes. H43.813 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).
H43.813 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.
Use this code only when documentation clearly indicates bilateral involvement.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H43.813 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when documentation clearly indicates bilateral involvement
- •Report this code once per encounter; do not report separately for each eye