H54.1131 ICD-10-CM Code: Blindness right eye category 3, low vision left eye category 1
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Visual disturbances and blindness (H53-H54)
H54.1131
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBlindness right eye category 3, low vision left eye category 1
A condition where the right eye is completely blind (category 3 blindness) and the left eye has low vision with near-normal vision (category 1 low vision), creating asymmetric vision loss.
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
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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H54.1131 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H54.1131 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H54.1131 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H54.1131 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H54.1131 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H54.1131 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H54.1131 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 H54.1131 an HCC code?
No. H54.1131 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
H54.1131 is the ICD-10-CM diagnosis code for blindness right eye category 3, low vision left eye category 1. A condition where the right eye is completely blind (category 3 blindness) and the left eye has low vision with near-normal vision (category 1 low vision), creating asymmetric vision loss. H54.1131 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).
H54.1131 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.
Category 1 low vision in the left eye indicates relatively better vision compared to the blind right eye; ensure this distinction is documented.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H54.1131 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Category 1 low vision in the left eye indicates relatively better vision compared to the blind right eye; ensure this distinction is documented.
- •The right eye is documented as category 3 blindness while the left eye is low vision category 1; verify both components are clearly stated in the record.