ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 H54.1131

Billable / Specific

Blindness right eye category 3, low vision left eye category 1

H54
Block
0
Synonyms
256
LCDs
13
Payer Policies
0
Linked CPTs

About ICD-10-CM H54.1131

ICD-10-CM code H54.1131 represents Blindness right eye category 3, low vision left eye category 1. This is a billable/specific code in the Eye and Adnexa chapter (block H54). The 2026 edition of ICD-10-CM H54.1131 became effective on October 1, 2025.

Medicare LCD Coverage for H54.1131

Local Coverage Determinations (LCDs) from CMS MACs that list H54.1131 as a covered diagnosis.

256 LCDs

Showing top 10 of 256 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Electroretinography (ERG)
Article ID: 57677, Effective: 2024-10-01 00:00:00, 653 covered, 1 non-covered
CPT 92274 →
CMS LCD: Billing and Coding: Electroretinography (ERG)
Article ID: 57677, Effective: 2024-10-01 00:00:00, 653 covered, 1 non-covered
CPT 0509T →
CMS LCD: Billing and Coding: Electroretinography (ERG)
Article ID: 57677, Effective: 2024-10-01 00:00:00, 653 covered, 1 non-covered
CPT 92273 →
CMS LCD: Billing and Coding: Physical Therapy - Home Health
Article ID: 57311, Effective: 2025-10-01 00:00:00, 14836 covered, 0 non-covered
CPT 97755 →
CMS LCD: Billing and Coding: Physical Therapy - Home Health
Article ID: 57311, Effective: 2025-10-01 00:00:00, 14836 covered, 0 non-covered
CPT 98966 →
CMS LCD: Billing and Coding: Physical Therapy - Home Health
Article ID: 57311, Effective: 2025-10-01 00:00:00, 14836 covered, 0 non-covered
CPT G0329 →
CMS LCD: Billing and Coding: Physical Therapy - Home Health
Article ID: 57311, Effective: 2025-10-01 00:00:00, 14836 covered, 0 non-covered
CPT 97022 →
CMS LCD: Billing and Coding: Physical Therapy - Home Health
Article ID: 57311, Effective: 2025-10-01 00:00:00, 14836 covered, 0 non-covered
CPT 97112 →
CMS LCD: Billing and Coding: Physical Therapy - Home Health
Article ID: 57311, Effective: 2025-10-01 00:00:00, 14836 covered, 0 non-covered
CPT 97034 →
CMS LCD: Billing and Coding: Physical Therapy - Home Health
Article ID: 57311, Effective: 2025-10-01 00:00:00, 14836 covered, 0 non-covered
CPT 97542 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing H54.1131.

13 policies

5 Medicare

Billing and Coding: Home Health Occupational Therapy
Policy ID: ART-53057
Billing and Coding: Outpatient Occupational Therapy
Policy ID: ART-53064
Billing and Coding: Visual Fields Testing
Policy ID: ART-56551
Billing and Coding: Electroretinography (ERG)
Policy ID: ART-56672
Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Policy ID: ART-56726

CPT Codes Commonly Billed with H54.1131

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for H54.1131

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.

ICD-10 H54.1131, Billing FAQ

Is ICD-10 code H54.1131 billable? +

Yes, H54.1131 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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