Question 1

What is ICD-10 code H54.0X34?

Accepted Answer

H54.0X34 is the ICD-10-CM diagnosis code for blindness right eye category 3, blindness left eye category 4. Severe vision loss in both eyes, with the right eye having severe vision loss (category 3) and the left eye having total blindness (category 4). H54.0X34 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).

H54.0X34 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.

The 'X' placeholder must be filled with the appropriate laterality indicator; verify correct code structure in your coding system.

Question 2

Is H54.0X34 an HCC code?

Accepted Answer

No. H54.0X34 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 H54.0X34 billable?

Accepted Answer

Yes. H54.0X34 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. H54.0X34 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 H54.0X34?

Accepted Answer

H54.0X34 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 H54.0X34 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 H54.0X34?

Accepted Answer

The 'X' placeholder must be filled with the appropriate laterality indicator; verify correct code structure in your coding system Category 4 represents total blindness with no light perception; ensure documentation clearly supports this distinction from category 3

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H54.0X34

Is H54.0X34 an HCC code?

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H54.0X34 ICD-10-CM Code: Blindness right eye category 3, blindness left eye category 4

HCC Buddy Code Card

H54.0X34

Is H54.0X34 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H54.0X34 in the Interactive Encoder