ICD-10 H36.819
Billable / Specific HCC v28: 46Nonproliferative sickle-cell retinopathy, unspecified eye
About ICD-10-CM H36.819
ICD-10-CM code H36.819 represents Nonproliferative sickle-cell retinopathy, unspecified eye. This is a billable/specific code in the Eye and Adnexa chapter (block H36). The 2026 edition of ICD-10-CM H36.819 became effective on October 1, 2025.
Coding Tips for H36.819
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
H36.819 is a CMS-HCC v28 risk-adjustment code (category 46). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for H36.819
Local Coverage Determinations (LCDs) from CMS MACs that list H36.819 as a covered diagnosis.
Showing top 4. Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing H36.819.
1 Medicare
CPT Codes Commonly Billed with H36.819
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To H36.819
Other codes in section H30-H36 (Disorders of choroid and retina).
ICD-10 H36.819, Billing FAQ
Is ICD-10 code H36.819 billable? +
Yes, H36.819 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does H36.819 affect Medicare Advantage HCC risk adjustment? +
Yes. H36.819 maps to CMS-HCC v28 category 46. Capture this diagnosis annually for accurate Medicare Advantage risk score.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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