H43.821 ICD-10-CM Code: Vitreomacular adhesion, right eye
H43.821 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of vitreous body and globe (H43-H44)
H43.821
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceVitreomacular adhesion, right eye
Abnormal adhesion or sticking between the vitreous gel and the macula (central part of the retina) in the right eye, which can affect vision.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Vitreomacular tractionInherited from H43.82
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59, H43.8
- certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59, H43.8
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59, H43.8
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59, H43.8
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59, H43.8
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59, H43.8
- injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59, H43.8
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59, H43.8
- neoplasms (C00-D49)Inherited from H00-H59, H43.8
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59, H43.8
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59, H43.8
- vitreous abscess (H44.02-)Inherited from H00-H59, H43.8
Related Codes
Includes
OfficialNo Includes notes are included in this display for H43.821. Check the code and parent instructions in the Code Book.
Excludes 1
Official- proliferative vitreo-retinopathy with retinal detachment (H33.4-)Inherited from H43.8
Code First
OfficialNo Code First sequencing instructions are included in this display for H43.821. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for H43.821. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for H43.821. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is H43.821 an HCC code?
No. H43.821 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- H43.821
- Description
- Vitreomacular adhesion, right eye
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
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
H43.821 is the ICD-10-CM diagnosis code for vitreomacular adhesion, right eye. Abnormal adhesion or sticking between the vitreous gel and the macula (central part of the retina) in the right eye, which can affect vision. H43.821 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).
H43.821 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Confirm the diagnosis specifies vitreomacular adhesion rather than vitreomacular traction.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H43.821 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm the diagnosis specifies vitreomacular adhesion rather than vitreomacular traction
- •Verify right eye laterality is documented before assigning this code