H51.11
BillableConvergence insufficiency
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H51.11 an HCC code?
No. H51.11 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
H51.11 is the ICD-10-CM diagnosis code for convergence insufficiency. A condition where the eyes have difficulty turning inward together to focus on near objects, making it hard to read or see things up close. H51.11 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).
H51.11 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.
Document whether this is primary (no underlying cause) or secondary to another condition.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H51.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether this is primary (no underlying cause) or secondary to another condition
- •Differentiate from convergence excess; insufficiency means inadequate convergence ability