Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesDisorders of choroid and retinaICD-10-CM h35-other-retinal-disorders
    Ask Trek AI about this page

    ICD-10-CM Code For Other Retinal Disorders: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group H35 includes various non-macular, non-vascular retinal disorders such as retinoschisis, retinitis pigmentosa, serous retinal detachments, and other degenerative or dystrophic retinal conditions. These ICD-10-CM diagnosis codes are used to document clinical encounters involving structural retinal disease, progressive retinal degeneration, or serous and tractional changes that affect retinal integrity and vision. Accurate coding within the ICD-10-CM H35 group supports proper claim adjudication and complete clinical documentation for appropriate reimbursement.

    Customize your policy alerts

    Sign up for ICD-10-CM Code For Other Retinal Disorders: Group Overview policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    ICD-10-CM H35: Other Retinal Disorders Overview

    The ICD-10-CM H35 group encompasses a range of retinal conditions that affect the neurosensory retina and retinal pigment epithelium, excluding the macular degeneration and vascular retinopathies specifically coded elsewhere. These diagnoses target retinal structural and degenerative disorders that can impair vision and ocular function. Accurate coding supports correct clinical classification and influences reimbursement and resource allocation.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    When to Use

    Use codes from this group when the clinical documentation identifies a specific non-macular, non-vascular retinal disorder such as retinoschisis, hereditary retinal dystrophy, or serous retinal detachment. Select the most specific H35 code that corresponds to the documented diagnosis, laterality, and any specified complications.

    ICD-10-CM Codes

    175 rows

    ICD-10-CM CodeDescription
    H35.00Unspecified background retinopathy
    H35.011Changes in retinal vascular appearance, right eye
    H35.012Changes in retinal vascular appearance, left eye
    H35.013Changes in retinal vascular appearance, bilateral
    H35.019Changes in retinal vascular appearance, unspecified eye
    H35.021Exudative retinopathy, right eye
    H35.022Exudative retinopathy, left eye
    H35.023Exudative retinopathy, bilateral
    H35.029Exudative retinopathy, unspecified eye
    H35.031Hypertensive retinopathy, right eye
    H35.032Hypertensive retinopathy, left eye
    H35.033Hypertensive retinopathy, bilateral
    H35.039Hypertensive retinopathy, unspecified eye
    H35.041Retinal micro-aneurysms, unspecified, right eye
    H35.042Retinal micro-aneurysms, unspecified, left eye
    H35.043Retinal micro-aneurysms, unspecified, bilateral
    H35.049Retinal micro-aneurysms, unspecified, unspecified eye
    H35.051Retinal neovascularization, unspecified, right eye
    H35.052Retinal neovascularization, unspecified, left eye
    H35.053Retinal neovascularization, unspecified, bilateral

    Showing 1–20 of 175

    • More pages

    DRG Codes

    2 rows

    DRG CodeDescription
    124Other Disorders of the Eye with MCC or Thrombolytic Agent
    125Other Disorders of the Eye without MCC

    Typical Clinical Scenarios

    • An elderly patient with gradual, bilateral central vision distortion reports increasing difficulty reading and seeing fine detail over months; fundus exam shows macular drusen, retinal pigment epithelial changes, and non-exudative geographic atrophy consistent with dry age-related macular degeneration, leading to assignment of a chronic degenerative retinal disorder code. Typical codes: H35.31, H35.32, H35.33.
    • A middle-aged patient presents to the emergency department with sudden onset of flashing lights and a curtain-like shadow in one eye after recent head trauma; ophthalmoscopy reveals a full-thickness macular hole or retinal tear requiring urgent retinal specialist evaluation, and an acute retinal break or macular hole code is used. Typical codes: H35.33, H35.3191.
    • A patient with longstanding diabetes is seen in clinic for worsening visual acuity and fundus exam shows myopic tractional changes with macular schisis and serous retinal detachment as a complication of high myopia; the encounter documents chronic myopic retinal degeneration and associated macular complications, prompting assignment of degenerative myopia-related retinal disorder codes. Typical codes: H35.70, H35.32, H35.3211.

    Related Codes

    H30-CHORIORETINAL-INFLAMMATION

    ICD-10-CM Code For Chorioretinal Inflammation: Group Overview

    H31-OTHER-DISORDERS-OF-CHOROID

    ICD-10-CM Code For Other Disorders Of Choroid: Group Overview

    H32-CHORIORETINAL-DISORDERS-SECONDARY

    ICD-10-CM Code For Chorioretinal Disorders In Diseases Classified Elsewhere: Group Overview

    H33-RETINAL-DETACHMENTS-AND-BREAKS

    ICD-10-CM Code For Retinal Detachments And Breaks: Group Overview

    H34-RETINAL-VASCULAR-OCCLUSIONS

    ICD-10-CM Code For Retinal Vascular Occlusions: Group Overview

    H36-RETINAL-DISORDERS-IN-DISEASES-CLASSIFIED-ELSEWHERE

    ICD-10-CM Code For Retinal Disorders In Diseases Classified Elsewhere: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.