H54.1215 ICD-10-CM Code: Low vision right eye category 1, blindness left eye category 5
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Visual disturbances and blindness (H53-H54)
H54.1215
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLow vision right eye category 1, blindness left eye category 5
This code describes a patient who has significant vision loss in the right eye (category 1 low vision, meaning visual acuity between 20/70 and 20/160) and complete blindness in the left eye (category 5, meaning no light perception). This represents asymmetrical vision loss affecting both eyes.
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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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H54.1215 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H54.1215 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H54.1215 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H54.1215 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H54.1215 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H54.1215 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H54.1215 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 H54.1215 an HCC code?
No. H54.1215 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
H54.1215 is the ICD-10-CM diagnosis code for low vision right eye category 1, blindness left eye category 5. This code describes a patient who has significant vision loss in the right eye (category 1 low vision, meaning visual acuity between 20/70 and 20/160) and complete blindness in the left eye (category 5, meaning no light perception). This represents asymmetrical vision loss affecting both eyes. H54.1215 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).
H54.1215 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 laterality and severity level for each eye separately, as this code requires precise classification of vision loss in both eyes.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H54.1215 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies the laterality and severity level for each eye separately, as this code requires precise classification of vision loss in both eyes
- •Ensure the ophthalmology or optometry report clearly documents the visual acuity measurements or light perception status to support the category assignments for accurate code selection