Question 1

What is ICD-10 code H54.52A2?

Accepted Answer

H54.52A2 is the ICD-10-CM diagnosis code for low vision left eye category 2, normal vision right eye. The left eye has low vision (category 2 severity), while the right eye has normal vision. H54.52A2 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).

H54.52A2 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.

This code requires documentation of vision status in both eyes; ensure the chart specifies low vision category 2 in the left eye.

Question 2

Is H54.52A2 an HCC code?

Accepted Answer

No. H54.52A2 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 H54.52A2 billable?

Accepted Answer

Yes. H54.52A2 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. H54.52A2 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 H54.52A2?

Accepted Answer

H54.52A2 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 H54.52A2 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 H54.52A2?

Accepted Answer

This code requires documentation of vision status in both eyes; ensure the chart specifies low vision category 2 in the left eye The 'A2' suffix indicates this is the initial encounter; use appropriate 7th character for subsequent encounters or sequelae

HCC Buddy Code Card

H54.52A2

Is H54.52A2 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H54.52A2 in the Interactive Encoder

H54.52A2 ICD-10-CM Code: Low vision left eye category 2, normal vision right eye

HCC Buddy Code Card

H54.52A2

Is H54.52A2 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H54.52A2 in the Interactive Encoder