H50.811
BillableDuane's syndrome, right eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H50.811 an HCC code?
No. H50.811 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
H50.811 is the ICD-10-CM diagnosis code for duane's syndrome, right eye. Duane's syndrome is a rare eye movement disorder where the affected eye has limited ability to move outward (away from the nose) and the eye may turn inward when looking to the side. This code specifically indicates the condition affects the right eye. H50.811 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of ocular muscles, binocular movement, accommodation and refraction (h49-h52).
H50.811 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.
Duane's syndrome is a congenital condition, so verify documentation confirms this is a congenital eye movement disorder rather than an acquired condition.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H50.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Duane's syndrome is a congenital condition, so verify documentation confirms this is a congenital eye movement disorder rather than an acquired condition
- •If the condition affects both eyes, code both H50.811 (right eye) and H50.812 (left eye) separately rather than using a bilateral code