H54.1142 ICD-10-CM Code: Blindness right eye category 4, low vision left eye category 2
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Visual disturbances and blindness (H53-H54)
H54.1142
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBlindness right eye category 4, low vision left eye category 2
This code describes a patient who is legally blind in the right eye (category 4 blindness) and has significant vision loss in the left eye (category 2 low vision). The patient has severe vision impairment affecting both eyes with different severity levels.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H54.1142 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H54.1142 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H54.1142 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H54.1142 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H54.1142 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H54.1142 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H54.1142 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 H54.1142 an HCC code?
No. H54.1142 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H54.1142 is the ICD-10-CM diagnosis code for blindness right eye category 4, low vision left eye category 2. This code describes a patient who is legally blind in the right eye (category 4 blindness) and has significant vision loss in the left eye (category 2 low vision). The patient has severe vision impairment affecting both eyes with different severity levels. H54.1142 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).
H54.1142 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.
Verify documentation specifies the severity level for each eye separately, as this code requires distinct classifications for right and left eyes.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H54.1142 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies the severity level for each eye separately, as this code requires distinct classifications for right and left eyes
- •Ensure the ophthalmology or optometry report includes visual acuity measurements or visual field testing to support the specific blindness/low vision categories assigned