Question 1

What is ICD-10 code H54.2X11?

Accepted Answer

H54.2X11 is the ICD-10-CM diagnosis code for low vision right eye category 1, low vision left eye category 1. Mild low vision in both eyes. The person has reduced vision in each eye but retains some functional sight. H54.2X11 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).

H54.2X11 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.

Both eyes are category 1 (mild low vision with acuity 6/18 to 6/24); verify visual acuity measurements are documented for both eyes.

Question 2

Is H54.2X11 an HCC code?

Accepted Answer

No. H54.2X11 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 H54.2X11 billable?

Accepted Answer

Yes. H54.2X11 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. H54.2X11 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 H54.2X11?

Accepted Answer

H54.2X11 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 H54.2X11 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 H54.2X11?

Accepted Answer

Both eyes are category 1 (mild low vision with acuity 6/18 to 6/24); verify visual acuity measurements are documented for both eyes. The 'X' in the code indicates the specific combination; ensure both eyes have similar mild vision loss severity.

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H54.2X11

Is H54.2X11 an HCC code?

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H54.2X11 ICD-10-CM Code: Low vision right eye category 1, low vision left eye category 1

HCC Buddy Code Card

H54.2X11

Is H54.2X11 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H54.2X11 in the Interactive Encoder