2027 ICD-10-CM Diagnosis Code H40.1131Primary open-angle glaucoma, bilateral, mild stage

ICD-10-CM Codes›H00–H59›H40-H42›H40

ICD-10-CM H40.1131
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

H40.1131 is a billable ICD-10-CM diagnosis code for primary open-angle glaucoma, bilateral, mild stage. The 7th character 1 means mild stage. 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Glaucoma.

H40.1131 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 243 and RxHCC Part D (V08) category 244 for payment year 2027.

Code Identity

ICD-10-CM Code
H40.1131
Billable Status
Yes — Valid for Submission
Code Describes
Primary open-angle glaucoma, bilateral, mild stage
Short Description
Primary open-angle glaucoma, bilateral, mild stage
Same as the full description in the CMS dataset.
Parent Code
H40.113
Primary open-angle glaucoma, bilateral

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH40-H42Glaucoma
CategoryH40Glaucoma
This CodeH40.1131Primary open-angle glaucoma, bilateral, mild stage

Quality Payment Program MeasuresBilling

Medicare quality measures that can apply when H40.1131 is part of the patient record.

Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 20% OR Documentation of a Plan of Care.

High Priority: YES

Measure Type: Outcome

Submission Methods: Claims, Registry

Description: Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 20% from the pre-intervention level) OR if the most recent IOP was not reduced by at least 20% from the pre-intervention level, a plan of care was documented within the 12 month performance period.

View Measure

Medicare Risk Adjustment (HCC)Billing

H40.1131 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model, but it maps to payment categories in the other CMS models shown below.

CMS-HCC V28 (Medicare Advantage Payment Model)
Not mapped
no payment category in the model that pays 100% of MA risk scores
Prior Model (CMS-HCC V24)
Not mapped under V24
this diagnosis newly risk-adjusts under the V28 model
Part D (RxHCC)
RxHCC 244 — Other Non-Acute Glaucoma
also risk-adjusts in the Part D prescription drug model (V08)

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 H40.1131: its own notes plus those printed at H40.11, H40, 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 H40 Glaucoma applies to 252 codes
  • absolute glaucoma (H44.51-)
  • congenital glaucoma (Q15.0)
  • traumatic glaucoma due to birth injury (P15.3)

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)

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

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.

From H40.11 Primary open-angle glaucoma applies to 20 codes
  • One of the following 7th characters is to be assigned to each code in subcategory H40.11 to designate the stage of glaucoma
Values for category H40.11 Glaucoma Stage
  • 0stage unspecified
  • 1mild stage this code
  • 2moderate stage
  • 3severe stage
  • 4indeterminate stage

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

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name H40.1131, its category, or a range that includes it.

Excludes2 1

These codes carry an Excludes2 note naming H40.1131: its condition is not part of those codes, and both may be reported when the patient has both.

  • H25 Age-related cataract
    capsular glaucoma with pseudoexfoliation of lens (H40.1-) names H40.1-, which includes this code

Clinical ClassificationClinical

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

CCSR EYE003
Glaucoma
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Primary Open Angle Glaucoma

    a form of glaucoma in which there is no visible abnormality in the trabecular meshwork.

  • Glaucoma, Open-Angle

    glaucoma in which the angle of the anterior chamber is open and the trabecular meshwork does not encroach on the base of the iris.

Patient EducationClinical

Glaucoma

Glaucoma is a group of diseases that can damage the optic nerve of one, or both, of your eyes. This can result in vision loss. There are different types of glaucoma, but the most common type is open-angle glaucoma. Other less common types include angle-closure glaucoma, and congenital glaucoma.

The full article covers:

  • What is glaucoma?
  • What causes glaucoma?
  • What are the symptoms of glaucoma?
  • How is glaucoma diagnosed?
  • What are the treatments for glaucoma?
  • Can glaucoma be prevented?

Read the full article at MedlinePlus

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

Convert H40.1131 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
365.11 Prim open angle glaucoma
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.
ICD-9-CM
365.71 Mild stage glaucoma
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.

Code History & ChangesHistory

Replacement H40.1131 replaces the following previously assigned code(s):

  • H40.11X1 - Primary open-angle glaucoma, mild stage
FY 2019AddedAdded to the ICD-10-CM code setEffective October 1, 2018.
FY 2020–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About H40.1131Overview

What is the ICD-10 code for primary open-angle glaucoma, bilateral, mild stage?

The ICD-10-CM code for primary open-angle glaucoma, bilateral, mild stage is H40.1131 (sometimes written as H401131). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is H40.1131 (Primary open-angle glaucoma, bilateral) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report primary open-angle glaucoma, bilateral, mild stage on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What does the 7th character 1 in H40.1131 mean?

The final character 1 means mild stage, in this case for the primary open-angle glaucoma. It comes from the 7th character list in the CMS Tabular List for this category.

What MS-DRG does H40.1131 group to?

When primary open-angle glaucoma, bilateral, mild stage 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.

Can H40.1131 be reported with a code from H44.51?

Not as a rule. The Excludes1 note at H40, which applies to H40.1131, lists "absolute glaucoma (H44.51-)". 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).

Does H40.1131 risk-adjust for Medicare Advantage payment?

Not for Medicare Advantage: H40.1131 maps to no category in the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 243 (Glaucoma, Open-Angle or Moderate/Severe Stage) and RxHCC Part D (V08) category 244 (Other Non-Acute Glaucoma).