2027 ICD-10-CM Diagnosis Code H36.829Proliferative sickle-cell retinopathy, unspecified eye

ICD-10-CM Codes›H00–H59›H30-H36›H36

ICD-10-CM H36.829
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

H36.829 is a billable ICD-10-CM diagnosis code for proliferative sickle-cell retinopathy, unspecified eye. 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 not accepted as a principal diagnosis by the Medicare Code Editor. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Retinal and vitreous conditions and Sickle cell trait/anemia.

For Medicare Advantage risk adjustment, H36.829 maps to CMS-HCC Category 108 (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major) under the V28 model, adding a risk factor of about 0.146 for a community, non-dual, aged beneficiary in payment year 2027.

Code Identity

ICD-10-CM Code
H36.829
Billable Status
Yes — Valid for Submission
Code Describes
Proliferative sickle-cell retinopathy, unspecified eye
Short Description
Proliferative sickle-cell retinopathy, unspecified eye
Same as the full description in the CMS dataset.
Parent Code
H36.82
Proliferative sickle-cell retinopathy

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH30-H36Disorders of choroid and retina
CategoryH36Retinal disorders in diseases classified elsewhere
This CodeH36.829Proliferative sickle-cell retinopathy, unspecified eye

Code EditsBilling

Medicare Code Editor checks that affect claim validity for H36.829.

Unacceptable principal diagnosis
There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Medicare Risk Adjustment (HCC)Billing

H36.829 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.

CMS-HCC V28 Category (Payment Model)
HCC 108— Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
Payment HCC · PY 2027 one of 39 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.146
community, non-dual, aged · ranges 0.098–0.416 across segments
Hierarchy
Superseded by HCC 107
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
HCC 46
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
PACE (CMS-HCC V22): HCC 46 · PACE (CMS-HCC V22): HCC 122 · ESRD (V21): HCC 46 · ESRD (V21): HCC 122 · ESRD (V24): HCC 46 · ESRD (V24): HCC 122
ESRD V21 weights: 0.180 dialysis, 0.766–1.325 functioning graft · ESRD V21 weights: 0.000 dialysis, 0.248–0.388 functioning graft · ESRD V24 weights: 0.223 dialysis, 0.748–4.064 functioning graft · ESRD V24 weights: 0.006 dialysis, 0.321–0.727 functioning graft
Part D (RxHCC)
Not mapped
H36.829 does not risk-adjust in the RxHCC prescription drug model

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 H36.829: its own notes plus those printed at H36 and Chapter 7. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From H36 Retinal disorders in diseases classified elsewhere applies to 9 codes

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.

From Chapter 7 (H00-H59) Diseases of the eye and adnexa applies to 2,677 codes
  • 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)

Code First

The underlying condition named in the note is sequenced before this code.

From H36 Retinal disorders in diseases classified elsewhere applies to 9 codes
  • underlying disease, such as:
  • lipid storage disorders (E75.-)
  • sickle-cell disorders (D57.-)

Notes

General instructions on how these codes are used.

From Chapter 7 (H00-H59) Diseases of the eye and adnexa applies to 2,677 codes
  • Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name H36.829, its category, or a range that includes it.

Excludes2 1

These codes carry an Excludes2 note naming H36.829: its condition is not part of those codes, and both may be reported when the patient has both.

  • H35.2 Other non-diabetic proliferative retinopathy
    proliferative sickle-cell retinopathy (H36.82-) names H36.82-, which includes this code

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR EYE005
Retinal and vitreous conditions
Default principal diagnosis: inpatient No · outpatient No
CCSR BLD005
Sickle cell trait/anemia
Default principal diagnosis: inpatient No · outpatient Yes

Patient EducationClinical

Retinal Disorders

Retinal disorders are conditions that affect the retina, the thin light-sensitive tissue at the back of your eye. The retina senses light and sends signals to your brain so you can see.

The full article covers:

  • What are retinal disorders?
  • What causes retinal disorders?
  • What are common retinal disorders?
  • What are the symptoms of retinal disorders?
  • How are retinal disorders diagnosed?
  • How are retinal disorders treated?
  • Can retinal disorders be prevented?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Code History & ChangesHistory

Replacement H36.829 replaces the following previously assigned code(s):

  • H35.20 - Other non-diabetic proliferative retinopathy, unsp eye
  • H35.21 - Other non-diabetic proliferative retinopathy, right eye
  • H35.22 - Other non-diabetic proliferative retinopathy, left eye
  • H35.23 - Other non-diabetic proliferative retinopathy, bilateral
FY 2024AddedAdded to the ICD-10-CM code setEffective October 1, 2023.
FY 2025–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About H36.829Overview

What is the ICD-10 code for proliferative sickle-cell retinopathy, unspecified eye?

The ICD-10-CM code for proliferative sickle-cell retinopathy, unspecified eye is H36.829 (sometimes written as H36829). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is H36.829 (Proliferative sickle-cell retinopathy) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report proliferative sickle-cell retinopathy, unspecified eye on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does H36.829 group to?

On inpatient claims, proliferative sickle-cell retinopathy, unspecified eye maps to MS-DRG 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.

Can H36.829 be a principal diagnosis?

No. The Medicare Code Editor rejects this code as a principal diagnosis because proliferative sickle-cell retinopathy, unspecified eye describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.

Can H36.829 be reported with a code from H35.0?

Not as a rule. The Excludes1 note at H36, which applies to H36.829, lists "arteriosclerotic retinopathy (H35.0-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).

What HCC is H36.829?

H36.829 (proliferative sickle-cell retinopathy, unspecified eye) maps to CMS-HCC Category 108 (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major), commonly written as HCC 108, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 46 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 H36.829 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, H36.829 adds a risk adjustment factor of about 0.146 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.098 to 0.416 depending on the payment segment). A more severe related category (HCC 107) supersedes it when both are reported. See the full factor table on the HCC 108 category page.