What does E11.65 map to in CMS-HCC V28?

On the live E11.65 card and in the PY2026 V28 map file, E11.65 maps to HCC 38 (CNA 0.166). E11.9 maps to the same HCC 38. E11.22 maps to HCC 37. HCC 36, 37, and 38 share 0.166, so E11.65 versus E11.9 does not change the diabetes dollar.

Does moving E11.9 to E11.65 raise the diabetes payment?

No. Both codes map to HCC 38. Both carry CNA 0.166. Moving E11.9 to E11.65 does not raise the diabetes dollar and does not open a second HCC.

Can I assign E11.65 from a lab A1C alone?

No. A standalone A1C is a lab. The provider must assess hyperglycemia this encounter. Do not code E11.65 from a lab value without that assessment.

If the chart also supports diabetic CKD, do I keep E11.65?

Use the chronic-complication combination the record supports (HCC 37). Hierarchy keeps one diabetes HCC. 37 supersedes 38. The E11.22 desk is the CKD plus N18 walk.

E11.65 Maps to HCC 38 in V28, Not HCC 37

E11.65 maps to V28 HCC 38 (CNA 0.166), the same bucket as E11.9. It does not map to HCC 37. Desk table for the leftover search pairing E11.65 with HCC 37.

CMS-HCC V28, payment year 2026: E11.9 and E11.65 map to HCC 38. Its community non-dual aged (CNA) coefficient is 0.166. This code-level reference is not a member’s total RAF score.

E11.65 maps to HCC 38. It does not map to HCC 37. The leftover search is "e11.65" "hcc 37" v28. That pairing is the miss.

Open the live E11.65, E11.9, and E11.22 cards before you invent a 37 row on the hyperglycemia code. This page is the desk table for that leftover. It is not a rewrite of the E11.22 desk. It is not the E11.52 leftover. It is not the I70.209 leftover.

*Current as of August 26, 2026. V28 mapping and CNA factors come from the live code pages named below and the 2026 Final ICD-10-CM Mappings. Non-PACE Medicare Advantage uses 100% V28 for payment year 2026. PACE follows a separate transition. Look the exact codes up. Do not code from this recap.*

Quick answer

No. E11.65 does not map to HCC 37. On the live card it maps to CMS-HCC V28 HCC 38, Diabetes with No, Glycemic, or Unspecified Complications. The source-labeled community non-dual aged reference coefficient is 0.166.

Code	What the row is naming	V28 payment HCC	CNA
E11.65	Type 2 DM with hyperglycemia	HCC 38	0.166
E11.9	Type 2 DM without complications	HCC 38	0.166
E11.22	Type 2 DM with diabetic CKD	HCC 37	0.166

Hyperglycemia is a glycemic finding. It is not diabetic CKD, neuropathy, retinopathy, or angiopathy. HCC 37 is chronic complications. HCC 38 is no, glycemic, or unspecified. E11.65 sits in 38.

36, 37, and 38 share 0.166

V28 constrained HCC 36, HCC 37, and HCC 38 to the same 0.166 community coefficient. Moving E11.9 to E11.65 does not raise the diabetes dollar and does not open a second HCC.

The E11.22 desk is the chronic-complication plus N18 walk. This page is the 37-vs-38 leftover.

Historical V24 mapping

E11.65 maps to HCC 18 in the CMS-HCC V24 column of the CMS 2025 Midyear/Final ICD-10-CM Mappings. This is a historical PY2025 reference. E11.9 maps to V24 HCC 19; E11.65 maps to V24 HCC 18. Both map to V28 HCC 38 for PY2026. The CMS 2026 Rate Announcement completes the V28 phase-in for non-PACE Medicare Advantage; PACE follows a separate transition.

What E11.65 needs

The provider must assess hyperglycemia this encounter. A standalone A1C is not enough.

Do not use E11.65 when the note supports ketoacidosis (E11.10 / E11.11) or hyperosmolarity (E11.00 / E11.01). Those map to HCC 36.

If the chart also supports CKD, neuropathy, retinopathy, or peripheral angiopathy, use that combination (HCC 37). Hierarchy keeps one diabetes HCC. 37 supersedes 38.

E11.65 has no Code First and no Use Additional on the live card.

Review documentation support

An HCC mapping does not establish reportability. Review the full eligible record and apply the official coding, encounter, program and payer requirements. A problem-list row from last year is not enough. See MEAT criteria and problem lists do not validate HCCs. MEAT is the training mnemonic. The authorities are the Official Guidelines and the record from the date of service.

Common misses

1. Reading with-hyperglycemia as HCC 37. E11.65 is HCC 38. HCC 37 is the chronic-complication bucket.

2. Expecting E11.65 to pay more than E11.9. Both are HCC 38. Both carry CNA 0.166.

3. Coding E11.65 from a lab only. A standalone A1C does not select E11.65.

4. Leaving E11.65 when a chronic-complication combination is supported. Use the combination (HCC 37). Hierarchy 37 over 38.

5. Mistaking a missing card value for no historical mapping. E11.65 maps to CMS-HCC V24 HCC 18 in the historical PY2025 file. Check the model and payment year.

Two-minute check

1. Confirm the provider assessed hyperglycemia this visit. Do not code from a lab only.

2. Assign E11.65 only when that assessment is in the note. Look that exact code up on HCC Buddy or in the encoder. Expect HCC 38, CNA 0.166.

3. Do not use E11.65 for ketoacidosis or hyperosmolarity. Those are HCC 36.

4. If the record supports CKD, neuropathy, retinopathy, or peripheral angiopathy, use that combination (HCC 37). 37 supersedes 38.

5. Review documentation support under the applicable official rules. Keep historical PY2025 V24 references separate from PY2026 V28.

E11.65: V28 HCC 38

E11.9: V28 HCC 38

E11.22: V28 HCC 37

E11.22 desk: chronic-complication plus N18 walk

Diabetes HCC guide · Combination codes

ICD-10 Encoder · MEAT criteria · Problem lists

Disclaimer

This article is for professional and educational use only. It is not coding, billing, legal, or medical advice. Verify every code, HCC map, and guideline section against current official CMS and ICD-10-CM guidance and your payer's policy before you assign it. Reading it creates no provider, patient, or advisory relationship.

By the HCC Buddy Coding Team. V28 mappings and CNA factors from the cited live code pages (CMS-HCC V28 PY2026 model software and ICD-10-CM mapping file). Not medical advice. Not a CMS-HCC model change beyond V28. Not a rewrite of the E11.22 leftover. Not an E11.52 leftover. Not an I70.209 leftover.