Is H26.011 a billable ICD-10-CM code?

Yes. H26.011 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H26.011 sit in the tabular list?

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

What cannot be coded together with H26.011?

H26.011 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H26.011 (H26) and apply to it just the same.

H26.011

H26.011 — Infantile and juvenile cortical, lamellar, or zonular cataract, right eye

Billable / specific codeICD-10-CMright

H26.011 is a billable, specific ICD-10-CM code for infantile and juvenile cortical, lamellar, or zonular cataract, right eye. It is valid for submission on a claim.

Excludes1 inherited from the categories above H26.011

These are not written on H26.011, but they bind it: a note on a category applies to every code beneath it. Billing H26.011 with anything listed here is a denial.

Written on H26 — Other cataract

congenital cataract (Q12.0)

Risk adjustment

H26.011 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

H26.011 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

H26.011 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 H26.01. If H26.011 is not quite right, the correct code is usually one of these.

Questions about H26.011

Is H26.011 a billable ICD-10-CM code?: Yes. H26.011 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H26.011 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of lens (H25-H28).
What cannot be coded together with H26.011?: H26.011 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H26.011 (H26) and apply to it just the same.