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HCC Condition Coding Guides

HCC condition coding guides explain which ICD-10-CM diagnosis codes map to CMS-HCC V28 payment categories, what RAF weights apply, and what documentation supports each condition.

Reviewed: April 25, 2026 | Updated for CMS-HCC V28 and FY2026 ICD-10-CM

Endocrine

Diabetes Mellitus (Type 2)

HCC 383HCC 298HCC 38HCC 37RAF 0.166 to 0.646

E11.9, E11.65, E11.311 and more

Morbid Obesity

HCC 48RAF 0.186

E66.01, E66.2, Z68.41 and more

Protein-Calorie Malnutrition

RAF None (V28)

and more

Cardiovascular

Heart Failure

HCC 226HCC 224HCC 225RAF 0.360

I50.20, I50.22, I50.23 and more

Atrial Fibrillation

HCC 238RAF 0.299

I48.0, I48.11, I48.19 and more

Peripheral Vascular Disease

HCC 263HCC 383HCC 264RAF 0.455 to 1.118

I70.221, I70.25, I70.231 and more

Stroke and Cerebrovascular Disease

HCC 253HCC 249RAF 0.239 to 0.387

I63.9, I63.50, I63.511 and more

Respiratory

Chronic Obstructive Pulmonary Disease (COPD)

HCC 213HCC 280RAF 0.319 to 0.370

J44.0, J44.1, J44.9 and more

Renal

Chronic Kidney Disease

HCC 326HCC 327HCC 329HCC 328RAF 0.127 to 0.815

N18.4, N18.5, N18.6 and more

Mental Health

Major Depressive Disorder

HCC 152HCC 155RAF 0.299 to 0.484

F32.1, F32.2, F32.3 and more

Dementia

HCC 127RAF 0.341

F01.50, F01.511, F02.80 and more

Schizophrenia

HCC 151RAF 0.511

F20.0, F20.1, F20.2 and more

Cancer

Lung Cancer

HCC 17HCC 20RAF 1.136 to 4.209

C34.10, C34.11, C34.12 and more

Breast Cancer

HCC 18HCC 23RAF 0.186 to 2.341

C50.011, C50.012, C50.411 and more

Infectious Disease

Hepatitis C

HCC 20HCC 64HCC 65RAF 0.185 to 1.136

B18.2, K74.60, K74.69 and more

HIV/AIDS

HCC 1RAF 0.301

B20, Z21, B97.35 and more

Musculoskeletal

Rheumatoid Arthritis

HCC 93RAF 0.617

M05.79, M05.10, M06.09 and more

Amputation Status

HCC 409RAF 0.598

Z89.511, Z89.512, Z89.611 and more

Dermatologic

Pressure Ulcers

HCC 379HCC 381HCC 382RAF 0.838 to 1.965

L89.154, L89.153, L89.014 and more

Transplant

Organ Transplant Status

HCC 276HCC 221HCC 35HCC 62RAF 0.376 to 2.531

Z94.1, Z94.2, Z94.3 and more

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