Question 1

What is ICD-10 code H53.031?

Accepted Answer

H53.031 is the ICD-10-CM diagnosis code for strabismic amblyopia, right eye. Strabismic amblyopia of the right eye develops when the right eye turns inward, outward, upward, or downward, causing the brain to suppress its image and rely on the other eye, resulting in poor vision development. H53.031 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).

H53.031 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 the direction of the eye turn (esotropia, exotropia, etc.) separately if documented.

Question 2

Is H53.031 an HCC code?

Accepted Answer

No. H53.031 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 H53.031 billable?

Accepted Answer

Yes. H53.031 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. H53.031 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 H53.031?

Accepted Answer

H53.031 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 H53.031 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 H53.031?

Accepted Answer

Document the direction of the eye turn (esotropia, exotropia, etc.) separately if documented Early treatment with patching, glasses, or surgery can help prevent permanent vision loss

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H53.031

Is H53.031 an HCC code?

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H53.031 ICD-10-CM Code: Strabismic amblyopia, right eye

HCC Buddy Code Card

H53.031

Is H53.031 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H53.031 in the Interactive Encoder