H35.54
H35.54: Dystrophies primarily involving the retinal pigment epithelium
Billable / specific codeICD-10-CM
H35.54 is a billable, specific ICD-10-CM code for dystrophies primarily involving the retinal pigment epithelium. It is valid for submission on a claim.
Check H35.54 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Vitelliform retinal dystrophy
Excludes1 inherited from the categories above H35.54
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above H35.54
Not part of this code, but both may be coded when both are present.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
H35.54 is named in 21 Medicare coverage policies: 21 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- A56551Billing and Coding: Visual Fields Testing
- A56672Billing and Coding: Electroretinography (ERG)
Alphabetic index entries that lead here
- Dystrophy, dystrophia›tapetoretinal
- Dystrophy, dystrophia›retinal›involving›pigment epithelium
Code history
Unchanged in every release from FY2024 to FY2027.