Is H25.043 a billable ICD-10-CM code?

Yes. H25.043 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H25.043 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of lens (H25-H28).

H25.043

H25.043 — Posterior subcapsular polar age-related cataract, bilateral

Billable / specific codeICD-10-CMbilateral

H25.043 is a billable, specific ICD-10-CM code for posterior subcapsular polar age-related cataract, bilateral. It is valid for submission on a claim.

Excludes2 inherited from the categories above H25.043

Also inherited, and the opposite of Excludes1: these conditions are not part of H25.043, but a patient can have both, so you may code both.

Written on H25 — Age-related cataract

capsular glaucoma with pseudoexfoliation of lens (H40.1-)

Risk adjustment

H25.043 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

H25.043 is named in 13 Medicare coverage policies — 13 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56453Billing and Coding: Cataract Extraction
A56453Billing and Coding: Cataract Extraction
A56544Billing and Coding: Cataract Extraction
A56549Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation

Code history

H25.043 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share H25.04. If H25.043 is not quite right, the correct code is usually one of these.

Questions about H25.043

Is H25.043 a billable ICD-10-CM code?: Yes. H25.043 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H25.043 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of lens (H25-H28).