H54.8 ICD-10-CM Code: Legal blindness, as defined in USA
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Visual disturbances and blindness (H53-H54)
H54.8
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLegal blindness, as defined in USA
This code describes a level of vision loss that meets the legal definition of blindness in the United States, typically meaning visual acuity of 20/200 or worse in the better eye, or a visual field of 20 degrees or less. It is used for documentation and billing purposes when a patient's vision impairment qualifies them for legal blindness status.
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
Code Trumping
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Code Book Path
Inclusion Terms
Official- Blindness NOS according to USA definition
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H54.8 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H54.8 in this effective period.
Excludes 1
Official- legal blindness with specification of impairment level (H54.0-H54.7)
Code First
Official- any associated underlying cause of the blindness
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H54.8 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H54.8 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 H54.8 an HCC code?
No. H54.8 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
H54.8 is the ICD-10-CM diagnosis code for legal blindness, as defined in usa. This code describes a level of vision loss that meets the legal definition of blindness in the United States, typically meaning visual acuity of 20/200 or worse in the better eye, or a visual field of 20 degrees or less. It is used for documentation and billing purposes when a patient's vision impairment qualifies them for legal blindness status. H54.8 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).
H54.8 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 the specific visual acuity measurements or visual field results in the medical record to confirm the patient meets legal blindness criteria before assigning this code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H54.8 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the specific visual acuity measurements or visual field results in the medical record to confirm the patient meets legal blindness criteria before assigning this code
- •Use the 5th character to specify laterality (right eye, left eye, or bilateral) as required by ICD-10-CM guidelines