2027 ICD-10-CM Diagnosis Code H35.3212Exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization
H35.3212 is a billable ICD-10-CM diagnosis code for exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization. The 7th character 2 means with inactive choroidal neovascularization. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 124 through 125. The code is restricted by the Medicare Code Editor to adult patients (age 15 through 124). In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Retinal and vitreous conditions.
For Medicare Advantage risk adjustment, H35.3212 maps to CMS-HCC Category 300 (Exudative Macular Degeneration) under the V28 model, adding a risk factor of about 0.596 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for H35.3212.
Medicare Risk Adjustment (HCC)Billing
H35.3212 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to H35.3212: its own notes plus those printed at H35.32, H35, and Chapter 7. A note printed at a category, block or chapter applies to every code under it.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury (trauma) of eye and orbit (S05.-)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)
Notes
General instructions on how these codes are used.
- Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition
7th Character
Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.
- One of the following 7th characters is to be assigned to codes in subcategory H35.32 to designate the stage of the disease:
- 0stage unspecified
- 1with active choroidal neovascularization
- 2with inactive choroidal neovascularization this code
- 3with inactive scar
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Macular Degeneration
Macular degeneration, or age-related macular degeneration (AMD), is a leading cause of vision loss in Americans 60 and older. It is a disease that destroys your sharp, central vision. You need central vision to see objects clearly and to do tasks such as reading and driving.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert H35.3212 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code History & ChangesHistory
Replacement H35.3212 replaces the following previously assigned code(s):
- H35.32 - Exudative age-related macular degeneration
Questions About H35.3212Overview
Is H35.3212 (Exudative age-related macular degeneration, right eye) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character 2 in H35.3212 mean?
The final character 2 means with inactive choroidal neovascularization, in this case for the exudative age-related macular degeneration. It comes from the 7th character list in the CMS Tabular List for this category.
What MS-DRG does H35.3212 group to?
When exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization is the principal diagnosis on an inpatient stay, it groups to MS-DRG 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.
Who can H35.3212 be reported for?
The Medicare Code Editor checks exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization against patient demographics: this code is intended for adult patients (age 15 through 124). Claims outside these limits are flagged as inconsistent.
What is the ICD-9 equivalent of H35.3212?
Under the General Equivalence Mappings, exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization converts to ICD-9-CM 362.52 (exudative macular degen). The mapping is approximate, so confirm the match fits the documentation.
What HCC is H35.3212?
H35.3212 (exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization) maps to CMS-HCC Category 300 (Exudative Macular Degeneration), commonly written as HCC 300, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 124 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does H35.3212 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, H35.3212 adds a risk adjustment factor of about 0.596 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.196 to 0.596 depending on the payment segment). HCC 300 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 300 category page.
