ICD-10 · PDGM grouping
H30-H36 — Disorders of choroid and retina
Every ICD-10-CM code in this range and the PDGM clinical group CMS assigns to it, read from the CMS grouper crosswalk v07.2.26.
ICD-10-CM FY2027 · CMS grouper v07.2.26
Codes in range
410
No clinical group
111
A period cannot be grouped from these.
Barred as primary
8
CMS rejects these in the primary position.
Where these codes group
299 of the 410 codes in H30-H36 group to MMTA - Other. A further 111 are assigned no clinical group at all, which means a 30-day period cannot be grouped from them.
Code families in H30-H36
One page per three-character family: every code in it, whether it can lead a claim, its clinical group and comorbidity subgroup.
- H30Chorioretinal inflammation56 codes
- H31Other disorders of choroid59 codes
- H32Chorioretinal disorders in diseases classified elsewhere1 code
- H33Retinal detachments and breaks65 codes
- H34Retinal vascular occlusions45 codes
- H35Other retinal disorders175 codes
- H36Retinal disorders in diseases classified elsewhere9 codes
Every code in H30-H36
Descriptions are CMS’s own, abbreviated as CMS abbreviates them.
| Code | Description | Clinical group | Primary position |
|---|---|---|---|
| H30001 | Unspecified focal chorioretinal inflammation, right eye | A | Can lead a claim |
| H30002 | Unspecified focal chorioretinal inflammation, left eye | A | Can lead a claim |
| H30003 | Unspecified focal chorioretinal inflammation, bilateral | A | Can lead a claim |
| H30009 | Unsp focal chorioretinal inflammation, unspecified eye | None | Cannot lead a claim |
| H30011 | Focal chorioretinal inflammation, juxtapapillary, right eye | A | Can lead a claim |
| H30012 | Focal chorioretinal inflammation, juxtapapillary, left eye | A | Can lead a claim |
| H30013 | Focal chorioretinal inflammation, juxtapapillary, bilateral | A | Can lead a claim |
| H30019 | Focal chorioretinal inflammation, juxtapapillary, unsp eye | None | Cannot lead a claim |
| H30021 | Focal chorioretin inflammation of posterior pole, right eye | A | Can lead a claim |
| H30022 | Focal chorioretinal inflammation of posterior pole, left eye | A | Can lead a claim |
| H30023 | Focal chorioretin inflammation of posterior pole, bilateral | A | Can lead a claim |
| H30029 | Focal chorioretinal inflammation of posterior pole, unsp eye | None | Cannot lead a claim |
| H30031 | Focal chorioretinal inflammation, peripheral, right eye | A | Can lead a claim |
| H30032 | Focal chorioretinal inflammation, peripheral, left eye | A | Can lead a claim |
| H30033 | Focal chorioretinal inflammation, peripheral, bilateral | A | Can lead a claim |
| H30039 | Focal chorioretinal inflammation, peripheral, unsp eye | None | Cannot lead a claim |
| H30041 | Focal chorioretin inflam, macular or paramacular, right eye | A | Can lead a claim |
| H30042 | Focal chorioretin inflam, macular or paramacular, left eye | A | Can lead a claim |
| H30043 | Focal chorioretin inflam, macular or paramacular, bilateral | A | Can lead a claim |
| H30049 | Focal chorioretin inflam, macular or paramacular, unsp eye | None | Cannot lead a claim |
| H30101 | Unsp disseminated chorioretinal inflammation, right eye | A | Can lead a claim |
| H30102 | Unsp disseminated chorioretinal inflammation, left eye | A | Can lead a claim |
| H30103 | Unsp disseminated chorioretinal inflammation, bilateral | A | Can lead a claim |
| H30109 | Unsp disseminated chorioretinal inflammation, unsp eye | None | Cannot lead a claim |
| H30111 | Dissem chorioretin inflammation of posterior pole, right eye | A | Can lead a claim |
| H30112 | Dissem chorioretin inflammation of posterior pole, left eye | A | Can lead a claim |
| H30113 | Dissem chorioretin inflammation of posterior pole, bilateral | A | Can lead a claim |
| H30119 | Dissem chorioretin inflammation of posterior pole, unsp eye | None | Cannot lead a claim |
| H30121 | Disseminated chorioretin inflammation, peripheral right eye | A | Can lead a claim |
| H30122 | Disseminated chorioretin inflammation, peripheral, left eye | A | Can lead a claim |
| H30123 | Disseminated chorioretin inflammation, peripheral, bilateral | A | Can lead a claim |
| H30129 | Disseminated chorioretin inflammation, peripheral, unsp eye | None | Cannot lead a claim |
| H30131 | Dissem chorioretin inflammation, generalized, right eye | A | Can lead a claim |
| H30132 | Disseminated chorioretin inflammation, generalized, left eye | A | Can lead a claim |
| H30133 | Dissem chorioretin inflammation, generalized, bilateral | A | Can lead a claim |
| H30139 | Disseminated chorioretin inflammation, generalized, unsp eye | None | Cannot lead a claim |
| H30141 | Acute post multifoc placoid pigment epitheliopathy, r eye | A | Can lead a claim |
| H30142 | Acute post multifoc placoid pigment epitheliopathy, left eye | A | Can lead a claim |
| H30143 | Acute posterior multifoc placoid pigment epitheliopathy, bi | A | Can lead a claim |
| H30149 | Acute post multifoc placoid pigment epitheliopathy, unsp eye | None | Cannot lead a claim |
| H3020 | Posterior cyclitis, unspecified eye | None | Cannot lead a claim |
| H3021 | Posterior cyclitis, right eye | A | Can lead a claim |
| H3022 | Posterior cyclitis, left eye | A | Can lead a claim |
| H3023 | Posterior cyclitis, bilateral | A | Can lead a claim |
| H30811 | Harada's disease, right eye | A | Can lead a claim |
| H30812 | Harada's disease, left eye | A | Can lead a claim |
| H30813 | Harada's disease, bilateral | A | Can lead a claim |
| H30819 | Harada's disease, unspecified eye | None | Cannot lead a claim |
| H30891 | Other chorioretinal inflammations, right eye | A | Can lead a claim |
| H30892 | Other chorioretinal inflammations, left eye | A | Can lead a claim |
| H30893 | Other chorioretinal inflammations, bilateral | A | Can lead a claim |
| H30899 | Other chorioretinal inflammations, unspecified eye | None | Cannot lead a claim |
| H3090 | Unspecified chorioretinal inflammation, unspecified eye | None | Cannot lead a claim |
| H3091 | Unspecified chorioretinal inflammation, right eye | A | Can lead a claim |
| H3092 | Unspecified chorioretinal inflammation, left eye | A | Can lead a claim |
| H3093 | Unspecified chorioretinal inflammation, bilateral | A | Can lead a claim |
| H31001 | Unspecified chorioretinal scars, right eye | A | Can lead a claim |
| H31002 | Unspecified chorioretinal scars, left eye | A | Can lead a claim |
| H31003 | Unspecified chorioretinal scars, bilateral | A | Can lead a claim |
| H31009 | Unspecified chorioretinal scars, unspecified eye | None | Cannot lead a claim |
| H31011 | Macula scars of posterior pole (post-traumatic), right eye | A | Can lead a claim |
| H31012 | Macula scars of posterior pole (post-traumatic), left eye | A | Can lead a claim |
| H31013 | Macula scars of posterior pole (post-traumatic), bilateral | A | Can lead a claim |
| H31019 | Macula scars of posterior pole (post-traumatic), unsp eye | None | Cannot lead a claim |
| H31021 | Solar retinopathy, right eye | A | Can lead a claim |
| H31022 | Solar retinopathy, left eye | A | Can lead a claim |
| H31023 | Solar retinopathy, bilateral | A | Can lead a claim |
| H31029 | Solar retinopathy, unspecified eye | None | Cannot lead a claim |
| H31091 | Other chorioretinal scars, right eye | A | Can lead a claim |
| H31092 | Other chorioretinal scars, left eye | A | Can lead a claim |
| H31093 | Other chorioretinal scars, bilateral | A | Can lead a claim |
| H31099 | Other chorioretinal scars, unspecified eye | None | Cannot lead a claim |
| H31101 | Choroidal degeneration, unspecified, right eye | A | Can lead a claim |
| H31102 | Choroidal degeneration, unspecified, left eye | A | Can lead a claim |
| H31103 | Choroidal degeneration, unspecified, bilateral | A | Can lead a claim |
| H31109 | Choroidal degeneration, unspecified, unspecified eye | None | Cannot lead a claim |
| H31111 | Age-related choroidal atrophy, right eye | A | Can lead a claim |
| H31112 | Age-related choroidal atrophy, left eye | A | Can lead a claim |
| H31113 | Age-related choroidal atrophy, bilateral | A | Can lead a claim |
| H31119 | Age-related choroidal atrophy, unspecified eye | None | Cannot lead a claim |
| H31121 | Diffuse secondary atrophy of choroid, right eye | A | Can lead a claim |
| H31122 | Diffuse secondary atrophy of choroid, left eye | A | Can lead a claim |
| H31123 | Diffuse secondary atrophy of choroid, bilateral | A | Can lead a claim |
| H31129 | Diffuse secondary atrophy of choroid, unspecified eye | None | Cannot lead a claim |
| H3120 | Hereditary choroidal dystrophy, unspecified | A | Can lead a claim |
| H3121 | Choroideremia | A | Can lead a claim |
| H3122 | Choroidal dystrophy (central areolar) (peripapillary) | A | Can lead a claim |
| H3123 | Gyrate atrophy, choroid | A | Can lead a claim |
| H3129 | Other hereditary choroidal dystrophy | A | Can lead a claim |
| H31301 | Unspecified choroidal hemorrhage, right eye | A | Can lead a claim |
| H31302 | Unspecified choroidal hemorrhage, left eye | A | Can lead a claim |
| H31303 | Unspecified choroidal hemorrhage, bilateral | A | Can lead a claim |
| H31309 | Unspecified choroidal hemorrhage, unspecified eye | None | Cannot lead a claim |
| H31311 | Expulsive choroidal hemorrhage, right eye | A | Can lead a claim |
| H31312 | Expulsive choroidal hemorrhage, left eye | A | Can lead a claim |
| H31313 | Expulsive choroidal hemorrhage, bilateral | A | Can lead a claim |
| H31319 | Expulsive choroidal hemorrhage, unspecified eye | None | Cannot lead a claim |
| H31321 | Choroidal rupture, right eye | A | Can lead a claim |
| H31322 | Choroidal rupture, left eye | A | Can lead a claim |
| H31323 | Choroidal rupture, bilateral | A | Can lead a claim |
| H31329 | Choroidal rupture, unspecified eye | None | Cannot lead a claim |
| H31401 | Unspecified choroidal detachment, right eye | A | Can lead a claim |
| H31402 | Unspecified choroidal detachment, left eye | A | Can lead a claim |
| H31403 | Unspecified choroidal detachment, bilateral | A | Can lead a claim |
| H31409 | Unspecified choroidal detachment, unspecified eye | None | Cannot lead a claim |
| H31411 | Hemorrhagic choroidal detachment, right eye | A | Can lead a claim |
| H31412 | Hemorrhagic choroidal detachment, left eye | A | Can lead a claim |
| H31413 | Hemorrhagic choroidal detachment, bilateral | A | Can lead a claim |
| H31419 | Hemorrhagic choroidal detachment, unspecified eye | None | Cannot lead a claim |
| H31421 | Serous choroidal detachment, right eye | A | Can lead a claim |
| H31422 | Serous choroidal detachment, left eye | A | Can lead a claim |
| H31423 | Serous choroidal detachment, bilateral | A | Can lead a claim |
| H31429 | Serous choroidal detachment, unspecified eye | None | Cannot lead a claim |
| H318 | Other specified disorders of choroid | A | Can lead a claim |
| H319 | Unspecified disorder of choroid | None | Cannot lead a claim |
| H32 | Chorioretinal disorders in diseases classified elsewhere | None | Cannot lead a claim |
| H33001 | Unspecified retinal detachment with retinal break, right eye | A | Can lead a claim |
| H33002 | Unspecified retinal detachment with retinal break, left eye | A | Can lead a claim |
| H33003 | Unspecified retinal detachment with retinal break, bilateral | A | Can lead a claim |
| H33009 | Unsp retinal detachment with retinal break, unspecified eye | None | Cannot lead a claim |
| H33011 | Retinal detachment with single break, right eye | A | Can lead a claim |
| H33012 | Retinal detachment with single break, left eye | A | Can lead a claim |
| H33013 | Retinal detachment with single break, bilateral | A | Can lead a claim |
| H33019 | Retinal detachment with single break, unspecified eye | None | Cannot lead a claim |
| H33021 | Retinal detachment with multiple breaks, right eye | A | Can lead a claim |
| H33022 | Retinal detachment with multiple breaks, left eye | A | Can lead a claim |
| H33023 | Retinal detachment with multiple breaks, bilateral | A | Can lead a claim |
| H33029 | Retinal detachment with multiple breaks, unspecified eye | None | Cannot lead a claim |
| H33031 | Retinal detachment with giant retinal tear, right eye | A | Can lead a claim |
| H33032 | Retinal detachment with giant retinal tear, left eye | A | Can lead a claim |
| H33033 | Retinal detachment with giant retinal tear, bilateral | A | Can lead a claim |
| H33039 | Retinal detachment with giant retinal tear, unspecified eye | None | Cannot lead a claim |
| H33041 | Retinal detachment with retinal dialysis, right eye | A | Can lead a claim |
| H33042 | Retinal detachment with retinal dialysis, left eye | A | Can lead a claim |
| H33043 | Retinal detachment with retinal dialysis, bilateral | A | Can lead a claim |
| H33049 | Retinal detachment with retinal dialysis, unspecified eye | None | Cannot lead a claim |
| H33051 | Total retinal detachment, right eye | A | Can lead a claim |
| H33052 | Total retinal detachment, left eye | A | Can lead a claim |
| H33053 | Total retinal detachment, bilateral | A | Can lead a claim |
| H33059 | Total retinal detachment, unspecified eye | None | Cannot lead a claim |
| H33101 | Unspecified retinoschisis, right eye | A | Can lead a claim |
| H33102 | Unspecified retinoschisis, left eye | A | Can lead a claim |
| H33103 | Unspecified retinoschisis, bilateral | A | Can lead a claim |
| H33109 | Unspecified retinoschisis, unspecified eye | None | Cannot lead a claim |
| H33111 | Cyst of ora serrata, right eye | A | Can lead a claim |
| H33112 | Cyst of ora serrata, left eye | A | Can lead a claim |
| H33113 | Cyst of ora serrata, bilateral | A | Can lead a claim |
| H33119 | Cyst of ora serrata, unspecified eye | None | Cannot lead a claim |
| H33121 | Parasitic cyst of retina, right eye | A | Can lead a claim |
| H33122 | Parasitic cyst of retina, left eye | A | Can lead a claim |
| H33123 | Parasitic cyst of retina, bilateral | A | Can lead a claim |
| H33129 | Parasitic cyst of retina, unspecified eye | None | Cannot lead a claim |
| H33191 | Other retinoschisis and retinal cysts, right eye | A | Can lead a claim |
| H33192 | Other retinoschisis and retinal cysts, left eye | A | Can lead a claim |
| H33193 | Other retinoschisis and retinal cysts, bilateral | A | Can lead a claim |
| H33199 | Other retinoschisis and retinal cysts, unspecified eye | None | Cannot lead a claim |
| H3320 | Serous retinal detachment, unspecified eye | None | Cannot lead a claim |
| H3321 | Serous retinal detachment, right eye | A | Can lead a claim |
| H3322 | Serous retinal detachment, left eye | A | Can lead a claim |
| H3323 | Serous retinal detachment, bilateral | A | Can lead a claim |
| H33301 | Unspecified retinal break, right eye | A | Can lead a claim |
| H33302 | Unspecified retinal break, left eye | A | Can lead a claim |
| H33303 | Unspecified retinal break, bilateral | A | Can lead a claim |
| H33309 | Unspecified retinal break, unspecified eye | None | Cannot lead a claim |
| H33311 | Horseshoe tear of retina without detachment, right eye | A | Can lead a claim |
| H33312 | Horseshoe tear of retina without detachment, left eye | A | Can lead a claim |
| H33313 | Horseshoe tear of retina without detachment, bilateral | A | Can lead a claim |
| H33319 | Horseshoe tear of retina without detachment, unspecified eye | None | Cannot lead a claim |
| H33321 | Round hole, right eye | A | Can lead a claim |
| H33322 | Round hole, left eye | A | Can lead a claim |
| H33323 | Round hole, bilateral | A | Can lead a claim |
| H33329 | Round hole, unspecified eye | None | Cannot lead a claim |
| H33331 | Multiple defects of retina without detachment, right eye | A | Can lead a claim |
| H33332 | Multiple defects of retina without detachment, left eye | A | Can lead a claim |
| H33333 | Multiple defects of retina without detachment, bilateral | A | Can lead a claim |
| H33339 | Multiple defects of retina without detachment, unsp eye | None | Cannot lead a claim |
| H3340 | Traction detachment of retina, unspecified eye | None | Cannot lead a claim |
| H3341 | Traction detachment of retina, right eye | A | Can lead a claim |
| H3342 | Traction detachment of retina, left eye | A | Can lead a claim |
| H3343 | Traction detachment of retina, bilateral | A | Can lead a claim |
| H338 | Other retinal detachments | A | Can lead a claim |
| H3400 | Transient retinal artery occlusion, unspecified eye | None | Cannot lead a claim |
| H3401 | Transient retinal artery occlusion, right eye | A | Can lead a claim |
| H3402 | Transient retinal artery occlusion, left eye | A | Can lead a claim |
| H3403 | Transient retinal artery occlusion, bilateral | A | Can lead a claim |
| H3410 | Central retinal artery occlusion, unspecified eye | None | Cannot lead a claim |
| H3411 | Central retinal artery occlusion, right eye | A | Can lead a claim |
| H3412 | Central retinal artery occlusion, left eye | A | Can lead a claim |
| H3413 | Central retinal artery occlusion, bilateral | A | Can lead a claim |
| H34211 | Partial retinal artery occlusion, right eye | A | Can lead a claim |
| H34212 | Partial retinal artery occlusion, left eye | A | Can lead a claim |
| H34213 | Partial retinal artery occlusion, bilateral | A | Can lead a claim |
| H34219 | Partial retinal artery occlusion, unspecified eye | None | Cannot lead a claim |
| H34231 | Retinal artery branch occlusion, right eye | A | Can lead a claim |
| H34232 | Retinal artery branch occlusion, left eye | A | Can lead a claim |
| H34233 | Retinal artery branch occlusion, bilateral | A | Can lead a claim |
| H34239 | Retinal artery branch occlusion, unspecified eye | None | Cannot lead a claim |
| H348110 | Central retinal vein occls, right eye, with macular edema | A | Can lead a claim |
| H348111 | Central retinal vein occlusion, right eye, w rtnl neovas | A | Can lead a claim |
| H348112 | Central retinal vein occlusion, right eye, stable | A | Can lead a claim |
| H348120 | Central retinal vein occlusion, left eye, with macular edema | A | Can lead a claim |
| H348121 | Central retinal vein occlusion, left eye, w rtnl neovas | A | Can lead a claim |
| H348122 | Central retinal vein occlusion, left eye, stable | A | Can lead a claim |
| H348130 | Central retinal vein occlusion, bi, with macular edema | A | Can lead a claim |
| H348131 | Central retinal vein occlusion, bilateral, w rtnl neovas | A | Can lead a claim |
| H348132 | Central retinal vein occlusion, bilateral, stable | A | Can lead a claim |
| H348190 | Central retinal vein occlusion, unsp, with macular edema | None | Cannot lead a claim |
| H348191 | Central retinal vein occlusion, unsp, w rtnl neovas | None | Cannot lead a claim |
| H348192 | Central retinal vein occlusion, unspecified eye, stable | None | Cannot lead a claim |
| H34821 | Venous engorgement, right eye | A | Can lead a claim |
| H34822 | Venous engorgement, left eye | A | Can lead a claim |
| H34823 | Venous engorgement, bilateral | A | Can lead a claim |
| H34829 | Venous engorgement, unspecified eye | None | Cannot lead a claim |
| H348310 | Trib rtnl vein occlusion, right eye, with macular edema | A | Can lead a claim |
| H348311 | Trib rtnl vein occlusion, right eye, w rtnl neovas | A | Can lead a claim |
| H348312 | Tributary (branch) retinal vein occlusion, right eye, stable | A | Can lead a claim |
| H348320 | Trib rtnl vein occlusion, left eye, with macular edema | A | Can lead a claim |
| H348321 | Trib rtnl vein occlusion, left eye, w rtnl neovas | A | Can lead a claim |
| H348322 | Tributary (branch) retinal vein occlusion, left eye, stable | A | Can lead a claim |
| H348330 | Trib rtnl vein occlusion, bilateral, with macular edema | A | Can lead a claim |
| H348331 | Trib rtnl vein occlusion, bilateral, w rtnl neovas | A | Can lead a claim |
| H348332 | Tributary (branch) retinal vein occlusion, bilateral, stable | A | Can lead a claim |
| H348390 | Trib rtnl vein occlusion, unsp, with macular edema | None | Cannot lead a claim |
| H348391 | Trib rtnl vein occlusion, unspecified eye, w rtnl neovas | None | Cannot lead a claim |
| H348392 | Trib rtnl vein occlusion, unspecified eye, stable | None | Cannot lead a claim |
| H349 | Unspecified retinal vascular occlusion | A | Can lead a claim |
| H3500 | Unspecified background retinopathy | A | Can lead a claim |
| H35011 | Changes in retinal vascular appearance, right eye | A | Can lead a claim |
| H35012 | Changes in retinal vascular appearance, left eye | A | Can lead a claim |
| H35013 | Changes in retinal vascular appearance, bilateral | A | Can lead a claim |
| H35019 | Changes in retinal vascular appearance, unspecified eye | None | Cannot lead a claim |
| H35021 | Exudative retinopathy, right eye | A | Can lead a claim |
| H35022 | Exudative retinopathy, left eye | A | Can lead a claim |
| H35023 | Exudative retinopathy, bilateral | A | Can lead a claim |
| H35029 | Exudative retinopathy, unspecified eye | None | Cannot lead a claim |
| H35031 | Hypertensive retinopathy, right eye | A | Can lead a claim |
| H35032 | Hypertensive retinopathy, left eye | A | Can lead a claim |
| H35033 | Hypertensive retinopathy, bilateral | A | Can lead a claim |
| H35039 | Hypertensive retinopathy, unspecified eye | None | Cannot lead a claim |
| H35041 | Retinal micro-aneurysms, unspecified, right eye | A | Can lead a claim |
| H35042 | Retinal micro-aneurysms, unspecified, left eye | A | Can lead a claim |
| H35043 | Retinal micro-aneurysms, unspecified, bilateral | A | Can lead a claim |
| H35049 | Retinal micro-aneurysms, unspecified, unspecified eye | None | Cannot lead a claim |
| H35051 | Retinal neovascularization, unspecified, right eye | A | Can lead a claim |
| H35052 | Retinal neovascularization, unspecified, left eye | A | Can lead a claim |
| H35053 | Retinal neovascularization, unspecified, bilateral | A | Can lead a claim |
| H35059 | Retinal neovascularization, unspecified, unspecified eye | None | Cannot lead a claim |
| H35061 | Retinal vasculitis, right eye | A | Can lead a claim |
| H35062 | Retinal vasculitis, left eye | A | Can lead a claim |
| H35063 | Retinal vasculitis, bilateral | A | Can lead a claim |
| H35069 | Retinal vasculitis, unspecified eye | None | Cannot lead a claim |
| H35071 | Retinal telangiectasis, right eye | A | Can lead a claim |
| H35072 | Retinal telangiectasis, left eye | A | Can lead a claim |
| H35073 | Retinal telangiectasis, bilateral | A | Can lead a claim |
| H35079 | Retinal telangiectasis, unspecified eye | None | Cannot lead a claim |
| H3509 | Other intraretinal microvascular abnormalities | A | Can lead a claim |
| H35101 | Retinopathy of prematurity, unspecified, right eye | A | Can lead a claim |
| H35102 | Retinopathy of prematurity, unspecified, left eye | A | Can lead a claim |
| H35103 | Retinopathy of prematurity, unspecified, bilateral | A | Can lead a claim |
| H35109 | Retinopathy of prematurity, unspecified, unspecified eye | None | Cannot lead a claim |
| H35111 | Retinopathy of prematurity, stage 0, right eye | A | Can lead a claim |
| H35112 | Retinopathy of prematurity, stage 0, left eye | A | Can lead a claim |
| H35113 | Retinopathy of prematurity, stage 0, bilateral | A | Can lead a claim |
| H35119 | Retinopathy of prematurity, stage 0, unspecified eye | None | Cannot lead a claim |
| H35121 | Retinopathy of prematurity, stage 1, right eye | A | Can lead a claim |
| H35122 | Retinopathy of prematurity, stage 1, left eye | A | Can lead a claim |
| H35123 | Retinopathy of prematurity, stage 1, bilateral | A | Can lead a claim |
| H35129 | Retinopathy of prematurity, stage 1, unspecified eye | None | Cannot lead a claim |
| H35131 | Retinopathy of prematurity, stage 2, right eye | A | Can lead a claim |
| H35132 | Retinopathy of prematurity, stage 2, left eye | A | Can lead a claim |
| H35133 | Retinopathy of prematurity, stage 2, bilateral | A | Can lead a claim |
| H35139 | Retinopathy of prematurity, stage 2, unspecified eye | None | Cannot lead a claim |
| H35141 | Retinopathy of prematurity, stage 3, right eye | A | Can lead a claim |
| H35142 | Retinopathy of prematurity, stage 3, left eye | A | Can lead a claim |
| H35143 | Retinopathy of prematurity, stage 3, bilateral | A | Can lead a claim |
| H35149 | Retinopathy of prematurity, stage 3, unspecified eye | None | Cannot lead a claim |
| H35151 | Retinopathy of prematurity, stage 4, right eye | A | Can lead a claim |
| H35152 | Retinopathy of prematurity, stage 4, left eye | A | Can lead a claim |
| H35153 | Retinopathy of prematurity, stage 4, bilateral | A | Can lead a claim |
| H35159 | Retinopathy of prematurity, stage 4, unspecified eye | None | Cannot lead a claim |
| H35161 | Retinopathy of prematurity, stage 5, right eye | A | Can lead a claim |
| H35162 | Retinopathy of prematurity, stage 5, left eye | A | Can lead a claim |
| H35163 | Retinopathy of prematurity, stage 5, bilateral | A | Can lead a claim |
| H35169 | Retinopathy of prematurity, stage 5, unspecified eye | None | Cannot lead a claim |
| H35171 | Retrolental fibroplasia, right eye | A | Can lead a claim |
| H35172 | Retrolental fibroplasia, left eye | A | Can lead a claim |
| H35173 | Retrolental fibroplasia, bilateral | A | Can lead a claim |
| H35179 | Retrolental fibroplasia, unspecified eye | None | Cannot lead a claim |
| H3520 | Other non-diabetic proliferative retinopathy, unsp eye | None | Cannot lead a claim |
| H3521 | Other non-diabetic proliferative retinopathy, right eye | A | Can lead a claim |
| H3522 | Other non-diabetic proliferative retinopathy, left eye | A | Can lead a claim |
| H3523 | Other non-diabetic proliferative retinopathy, bilateral | A | Can lead a claim |
| H3530 | Unspecified macular degeneration | None | Cannot lead a claim |
| H353110 | Nexdtve age-related mclr degn, right eye, stage unspecified | A | Can lead a claim |
| H353111 | Nexdtve age-related mclr degn, right eye, early dry stage | A | Can lead a claim |
| H353112 | Nexdtve age-related mclr degn, right eye, intermed dry stage | A | Can lead a claim |
| H353113 | Nexdtve age-rel mclr degn, r eye, adv atrpc w/o sbfvl invl | A | Can lead a claim |
| H353114 | Nexdtve age-rel mclr degn, r eye, adv atrpc with sbfvl invl | A | Can lead a claim |
| H353120 | Nexdtve age-related mclr degn, left eye, stage unspecified | A | Can lead a claim |
| H353121 | Nexdtve age-related mclr degn, left eye, early dry stage | A | Can lead a claim |
| H353122 | Nexdtve age-related mclr degn, left eye, intermed dry stage | A | Can lead a claim |
| H353123 | Nexdtve age-rel mclr degn, l eye, adv atrpc w/o sbfvl invl | A | Can lead a claim |
| H353124 | Nexdtve age-rel mclr degn, l eye, adv atrpc with sbfvl invl | A | Can lead a claim |
| H353130 | Nexdtve age-related mclr degn, bilateral, stage unspecified | A | Can lead a claim |
| H353131 | Nexdtve age-related mclr degn, bilateral, early dry stage | A | Can lead a claim |
| H353132 | Nexdtve age-related mclr degn, bilateral, intermed dry stage | A | Can lead a claim |
| H353133 | Nexdtve age-rel mclr degn, bi, adv atrpc without sbfvl invl | A | Can lead a claim |
| H353134 | Nexdtve age-rel mclr degn, bi, adv atrpc with subfoveal invl | A | Can lead a claim |
| H353190 | Nonexudative age-related mclr degn, unsp, stage unspecified | None | Cannot lead a claim |
| H353191 | Nonexudative age-related mclr degn, unsp, early dry stage | None | Cannot lead a claim |
| H353192 | Nonexudative age-related mclr degn, unsp, intermed dry stage | None | Cannot lead a claim |
| H353193 | Nexdtve age-rel mclr degn, unsp, adv atrpc w/o sbfvl invl | None | Cannot lead a claim |
| H353194 | Nexdtve age-rel mclr degn, unsp, adv atrpc with sbfvl invl | None | Cannot lead a claim |
| H353210 | Exudative age-rel mclr degn, right eye, stage unspecified | None | Cannot lead a claim |
| H353211 | Exdtve age-rel mclr degn, right eye, with actv chrdl neovas | A | Can lead a claim |
| H353212 | Exdtve age-rel mclr degn, right eye, with inact chrdl neovas | A | Can lead a claim |
| H353213 | Exudative age-rel mclr degn, right eye, with inactive scar | A | Can lead a claim |
| H353220 | Exudative age-related mclr degn, left eye, stage unspecified | None | Cannot lead a claim |
| H353221 | Exdtve age-rel mclr degn, left eye, with actv chrdl neovas | A | Can lead a claim |
| H353222 | Exdtve age-rel mclr degn, left eye, with inact chrdl neovas | A | Can lead a claim |
| H353223 | Exudative age-rel mclr degn, left eye, with inactive scar | A | Can lead a claim |
| H353230 | Exudative age-rel mclr degn, bilateral, stage unspecified | A | Can lead a claim |
| H353231 | Exudative age-rel mclr degn, bi, with actv chrdl neovas | A | Can lead a claim |
| H353232 | Exudative age-rel mclr degn, bi, with inact chrdl neovas | A | Can lead a claim |
| H353233 | Exudative age-rel mclr degn, bilateral, with inactive scar | A | Can lead a claim |
| H353290 | Exudative age-related mclr degn, unsp, stage unspecified | None | Cannot lead a claim |
| H353291 | Exudative age-rel mclr degn, unsp, with actv chrdl neovas | None | Cannot lead a claim |
| H353292 | Exudative age-rel mclr degn, unsp, with inact chrdl neovas | None | Cannot lead a claim |
| H353293 | Exudative age-related mclr degn, unsp, with inactive scar | None | Cannot lead a claim |
| H3533 | Angioid streaks of macula | A | Can lead a claim |
| H35341 | Macular cyst, hole, or pseudohole, right eye | A | Can lead a claim |
| H35342 | Macular cyst, hole, or pseudohole, left eye | A | Can lead a claim |
| H35343 | Macular cyst, hole, or pseudohole, bilateral | A | Can lead a claim |
| H35349 | Macular cyst, hole, or pseudohole, unspecified eye | None | Cannot lead a claim |
| H35351 | Cystoid macular degeneration, right eye | A | Can lead a claim |
| H35352 | Cystoid macular degeneration, left eye | A | Can lead a claim |
| H35353 | Cystoid macular degeneration, bilateral | A | Can lead a claim |
| H35359 | Cystoid macular degeneration, unspecified eye | None | Cannot lead a claim |
| H35361 | Drusen (degenerative) of macula, right eye | A | Can lead a claim |
| H35362 | Drusen (degenerative) of macula, left eye | A | Can lead a claim |
| H35363 | Drusen (degenerative) of macula, bilateral | A | Can lead a claim |
| H35369 | Drusen (degenerative) of macula, unspecified eye | None | Cannot lead a claim |
| H35371 | Puckering of macula, right eye | A | Can lead a claim |
| H35372 | Puckering of macula, left eye | A | Can lead a claim |
| H35373 | Puckering of macula, bilateral | A | Can lead a claim |
| H35379 | Puckering of macula, unspecified eye | None | Cannot lead a claim |
| H35381 | Toxic maculopathy, right eye | A | Can lead a claim, code first applies |
| H35382 | Toxic maculopathy, left eye | A | Can lead a claim, code first applies |
| H35383 | Toxic maculopathy, bilateral | A | Can lead a claim, code first applies |
| H35389 | Toxic maculopathy, unspecified eye | None | Cannot lead a claim |
| H3540 | Unspecified peripheral retinal degeneration | None | Cannot lead a claim |
| H35411 | Lattice degeneration of retina, right eye | A | Can lead a claim |
| H35412 | Lattice degeneration of retina, left eye | A | Can lead a claim |
| H35413 | Lattice degeneration of retina, bilateral | A | Can lead a claim |
| H35419 | Lattice degeneration of retina, unspecified eye | None | Cannot lead a claim |
| H35421 | Microcystoid degeneration of retina, right eye | A | Can lead a claim |
| H35422 | Microcystoid degeneration of retina, left eye | A | Can lead a claim |
| H35423 | Microcystoid degeneration of retina, bilateral | A | Can lead a claim |
| H35429 | Microcystoid degeneration of retina, unspecified eye | None | Cannot lead a claim |
| H35431 | Paving stone degeneration of retina, right eye | A | Can lead a claim |
| H35432 | Paving stone degeneration of retina, left eye | A | Can lead a claim |
| H35433 | Paving stone degeneration of retina, bilateral | A | Can lead a claim |
| H35439 | Paving stone degeneration of retina, unspecified eye | None | Cannot lead a claim |
| H35441 | Age-related reticular degeneration of retina, right eye | A | Can lead a claim |
| H35442 | Age-related reticular degeneration of retina, left eye | A | Can lead a claim |
| H35443 | Age-related reticular degeneration of retina, bilateral | A | Can lead a claim |
| H35449 | Age-related reticular degeneration of retina, unsp eye | None | Cannot lead a claim |
| H35451 | Secondary pigmentary degeneration, right eye | A | Can lead a claim |
| H35452 | Secondary pigmentary degeneration, left eye | A | Can lead a claim |
| H35453 | Secondary pigmentary degeneration, bilateral | A | Can lead a claim |
| H35459 | Secondary pigmentary degeneration, unspecified eye | None | Cannot lead a claim |
| H35461 | Secondary vitreoretinal degeneration, right eye | A | Can lead a claim |
| H35462 | Secondary vitreoretinal degeneration, left eye | A | Can lead a claim |
| H35463 | Secondary vitreoretinal degeneration, bilateral | A | Can lead a claim |
| H35469 | Secondary vitreoretinal degeneration, unspecified eye | None | Cannot lead a claim |
| H3550 | Unspecified hereditary retinal dystrophy | A | Can lead a claim |
| H3551 | Vitreoretinal dystrophy | A | Can lead a claim |
| H3552 | Pigmentary retinal dystrophy | A | Can lead a claim |
| H3553 | Other dystrophies primarily involving the sensory retina | A | Can lead a claim |
| H3554 | Dystrophies primarily w the retinal pigment epithelium | A | Can lead a claim |
| H3560 | Retinal hemorrhage, unspecified eye | None | Cannot lead a claim |
| H3561 | Retinal hemorrhage, right eye | A | Can lead a claim |
| H3562 | Retinal hemorrhage, left eye | A | Can lead a claim |
| H3563 | Retinal hemorrhage, bilateral | A | Can lead a claim |
| H3570 | Unspecified separation of retinal layers | None | Cannot lead a claim |
| H35711 | Central serous chorioretinopathy, right eye | A | Can lead a claim |
| H35712 | Central serous chorioretinopathy, left eye | A | Can lead a claim |
| H35713 | Central serous chorioretinopathy, bilateral | A | Can lead a claim |
| H35719 | Central serous chorioretinopathy, unspecified eye | None | Cannot lead a claim |
| H35721 | Serous detachment of retinal pigment epithelium, right eye | A | Can lead a claim |
| H35722 | Serous detachment of retinal pigment epithelium, left eye | A | Can lead a claim |
| H35723 | Serous detachment of retinal pigment epithelium, bilateral | A | Can lead a claim |
| H35729 | Serous detachment of retinal pigment epithelium, unsp eye | None | Cannot lead a claim |
| H35731 | Hemorrhagic detach of retinal pigment epithelium, right eye | A | Can lead a claim |
| H35732 | Hemorrhagic detach of retinal pigment epithelium, left eye | A | Can lead a claim |
| H35733 | Hemorrhagic detach of retinal pigment epithelium, bilateral | A | Can lead a claim |
| H35739 | Hemorrhagic detach of retinal pigment epithelium, unsp eye | None | Cannot lead a claim |
| H3581 | Retinal edema | A | Can lead a claim |
| H3582 | Retinal ischemia | A | Can lead a claim |
| H3589 | Other specified retinal disorders | A | Can lead a claim |
| H359 | Unspecified retinal disorder | None | Cannot lead a claim |
| H36811 | Nonproliferative sickle-cell retinopathy, right eye | None | Cannot lead a claim |
| H36812 | Nonproliferative sickle-cell retinopathy, left eye | None | Cannot lead a claim |
| H36813 | Nonproliferative sickle-cell retinopathy, bilateral | None | Cannot lead a claim |
| H36819 | Nonproliferative sickle-cell retinopathy, unspecified eye | None | Cannot lead a claim |
| H36821 | Proliferative sickle-cell retinopathy, right eye | None | Cannot lead a claim |
| H36822 | Proliferative sickle-cell retinopathy, left eye | None | Cannot lead a claim |
| H36823 | Proliferative sickle-cell retinopathy, bilateral | None | Cannot lead a claim |
| H36829 | Proliferative sickle-cell retinopathy, unspecified eye | None | Cannot lead a claim |
| H3689 | Other retinal disorders in diseases classified elsewhere | None | Cannot lead a claim |
Source: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
The monthly home health regs digest
What CMS changed, what's due next, and what to do about it — one email a month, no fluff. Read the first issue