H53.002 ICD-10-CM Code: Unspecified amblyopia, left eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Visual disturbances and blindness (H53-H54)
H53.002
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified amblyopia, left eye
Amblyopia, commonly known as lazy eye, is a condition where one eye doesn't develop normal vision during childhood, even though the eye itself is structurally normal. This code specifically indicates the left eye is affected, but the underlying cause hasn't been specified.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H53.002 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H53.002 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H53.002 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H53.002 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H53.002 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H53.002 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H53.002 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H53.002 an HCC code?
No. H53.002 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
H53.002 is the ICD-10-CM diagnosis code for unspecified amblyopia, left eye. Amblyopia, commonly known as lazy eye, is a condition where one eye doesn't develop normal vision during childhood, even though the eye itself is structurally normal. This code specifically indicates the left eye is affected, but the underlying cause hasn't been specified. H53.002 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering visual disturbances and blindness (h53-h54).
H53.002 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.
Always attempt to obtain the specific type of amblyopia (deprivation, strabismic, refractive, or anisometropic) from the clinical documentation, as unspecified codes may result in lower reimbursement or require query to the provider.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H53.002 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always attempt to obtain the specific type of amblyopia (deprivation, strabismic, refractive, or anisometropic) from the clinical documentation, as unspecified codes may result in lower reimbursement or require query to the provider
- •Verify laterality is correctly documented as left eye only; if both eyes are affected, you would need separate codes for each eye or use a bilateral code if available