Question 1

What is ICD-10 code H44.2B1?

Accepted Answer

H44.2B1 is the ICD-10-CM diagnosis code for degenerative myopia with macular hole, right eye. A severe form of progressive nearsightedness in the right eye that has caused a hole to develop in the macula, the central part of the retina responsible for detailed vision. H44.2B1 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).

H44.2B1 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 code indicates both degenerative myopia and macular hole as a complication; do not code macular hole separately.

Question 2

Is H44.2B1 an HCC code?

Accepted Answer

No. H44.2B1 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H44.2B1 billable?

Accepted Answer

Yes. H44.2B1 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H44.2B1 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for H44.2B1?

Accepted Answer

H44.2B1 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards H44.2B1 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H44.2B1?

Accepted Answer

This code indicates both degenerative myopia and macular hole as a complication; do not code macular hole separately Document whether surgical repair (vitrectomy) was performed, as this affects procedure coding

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H44.2B1 ICD-10-CM Code: Degenerative myopia with macular hole, right eye

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H44.2B1

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