Question 1

What is ICD-10 code H54.1152?

Accepted Answer

H54.1152 is the ICD-10-CM diagnosis code for blindness right eye category 5, low vision left eye category 2. Complete blindness in the right eye with moderate low vision in the left eye. The person relies on the left eye for vision. H54.1152 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).

H54.1152 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.

Confirm documentation specifies right eye category 5 (complete blindness) and left eye category 2 (moderate low vision with acuity 6/24 to 6/36).

Question 2

Is H54.1152 an HCC code?

Accepted Answer

No. H54.1152 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 H54.1152 billable?

Accepted Answer

Yes. H54.1152 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. H54.1152 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 H54.1152?

Accepted Answer

H54.1152 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 H54.1152 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 H54.1152?

Accepted Answer

Confirm documentation specifies right eye category 5 (complete blindness) and left eye category 2 (moderate low vision with acuity 6/24 to 6/36). This combination indicates the patient has some functional vision through the left eye only; document any visual rehabilitation or assistive devices being used.

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H54.1152

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H54.1152 ICD-10-CM Code: Blindness right eye category 5, low vision left eye category 2

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H54.1152

Is H54.1152 an HCC code?

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