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H54.1225 ICD-10-CM Code: Low vision right eye category 2, 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)

H54.1225

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Low vision right eye category 2, blindness left eye category 5

Moderate low vision in the right eye with complete blindness in the left eye. The person has only the right eye for vision.

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

Official
H54.12Blindness, left eye, low vision right eye
H54.122Low vision right eye category 2, blindness left eye
H54.1225Low vision right eye category 2, blindness left eye category 5

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H54.1225 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H54.1225 in this effective period.

Related Child Codes

Official
H54.1223Low vision right eye category 2, blindness left eye category 3
H54.1224Low vision right eye category 2, blindness left eye category 4

Includes

Official

ICD-10-CM does not list Includes notes for H54.1225 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H54.1225 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H54.1225 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H54.1225 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H54.1225 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Confirm right eye is category 2 (moderate low vision) and left eye is category 5 (complete blindness with no light perception).
Document the etiology of complete blindness in the left eye and any visual aids or rehabilitation services for the right eye.

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 H54.1225 an HCC code?

No. H54.1225 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

H54.1225 is the ICD-10-CM diagnosis code for low vision right eye category 2, blindness left eye category 5. Moderate low vision in the right eye with complete blindness in the left eye. The person has only the right eye for vision. H54.1225 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).

H54.1225 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 right eye is category 2 (moderate low vision) and left eye is category 5 (complete blindness with no light perception).

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H54.1225 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Confirm right eye is category 2 (moderate low vision) and left eye is category 5 (complete blindness with no light perception).
  • •Document the etiology of complete blindness in the left eye and any visual aids or rehabilitation services for the right eye.

Child Codes

H54.1223Low vision right eye category 2, blindness left eye category 3
H54.1224Low vision right eye category 2, blindness left eye category 4
H54.1225Low vision right eye category 2, blindness left eye category 5

Code Hierarchy

└H54Blindness and low vision└H54.1Blindness, one eye, low vision other eye└H54.12Blindness, left eye, low vision right eye└H54.122Low vision right eye category 2, blindness left eye└H54.1225Low vision right eye category 2, blindness left eye category 5
└H54.1225Low vision right eye category 2, blindness left eye category 5

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