CMS-HCC V28
CMS-HCC V28 payment categories
Every CMS-HCC V28 payment category with at least one payable ICD-10-CM code, for payment year 2026 (100 percent phase-in). Open a category for its RAF segment factors, V28 hierarchy, and member codes. For the model overview, see the V28 changes guide and the ICD-10 to HCC crosswalk.
CMS-HCC V28115 payment categories
All 115 V28 categories
Sorted by HCC number. The count is the payable ICD-10-CM codes that map to each category.
- HCC 1 HIV/AIDS3
- HCC 2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock52
- HCC 6 Opportunistic Infections37
- HCC 17 Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic78
- HCC 18 Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid26
- HCC 19 Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers68
- HCC 20 Lung and Other Severe Cancers233
- HCC 21 Lymphoma and Other Cancers463
- HCC 22 Bladder, Colorectal, and Other Cancers126
- HCC 23 Prostate, Breast, and Other Cancers and Tumors234
- HCC 35 Pancreas Transplant Status1
- HCC 36 Diabetes with Severe Acute Complications18
- HCC 37 Diabetes with Chronic Complications308
- HCC 38 Diabetes with No, Glycemic, or Unspecified Complications17
- HCC 48 Morbid Obesity9
- HCC 49 Specified Lysosomal Storage Disorders13
- HCC 50 Amyloidosis, Porphyria, and Other Specified Metabolic Disorders31
- HCC 51 Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders11
- HCC 62 Liver Transplant Status/Complications7
- HCC 63 Chronic Liver Failure/End-Stage Liver Disorders14
- HCC 64 Cirrhosis of Liver6
- HCC 65 Chronic Hepatitis17
- HCC 68 Cholangitis and Obstruction of Bile Duct Without Gallstones8
- HCC 77 Intestine Transplant Status/Complications6
- HCC 78 Intestinal Obstruction/Perforation76
- HCC 79 Chronic Pancreatitis2
- HCC 80 Crohn's Disease (Regional Enteritis)28
- HCC 81 Ulcerative Colitis49
- HCC 92 Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis609
- HCC 93 Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders508
- HCC 94 Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders71
- HCC 107 Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero14
- HCC 108 Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major39
- HCC 109 Acquired Hemolytic, Aplastic, and Sideroblastic Anemias37
- HCC 111 Hemophilia, Male2
- HCC 112 Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions21
- HCC 114 Common Variable and Combined Immunodeficiencies18
- HCC 115 Specified Immunodeficiencies and White Blood Cell Disorders18
- HCC 125 Dementia, Severe18
- HCC 126 Dementia, Moderate18
- HCC 127 Dementia, Mild or Unspecified65
- HCC 135 Drug Use with Psychotic Complications97
- HCC 136 Alcohol Use with Psychotic Complications19
- HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications308
- HCC 138 Drug Use Disorder, Mild, Uncomplicated, Except Cannabis14
- HCC 139 Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications27
- HCC 151 Schizophrenia12
- HCC 152 Psychosis, Except Schizophrenia12
- HCC 153 Personality Disorders; Anorexia/Bulimia Nervosa35
- HCC 154 Bipolar Disorders without Psychosis27
- HCC 155 Major Depression, Moderate or Severe, without Psychosis371
- HCC 180 Quadriplegia33
- HCC 181 Paraplegia18
- HCC 182 Spinal Cord Disorders/Injuries251
- HCC 190 Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease, Spinal Muscular Atrophy11
- HCC 191 Quadriplegic Cerebral Palsy1
- HCC 192 Cerebral Palsy, Except Quadriplegic9
- HCC 193 Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy2
- HCC 195 Myasthenia Gravis with (Acute) Exacerbation1
- HCC 196 Myasthenia Gravis without (Acute) Exacerbation and Other Myoneural Disorders9
- HCC 197 Muscular Dystrophy21
- HCC 198 Multiple Sclerosis19
- HCC 199 Parkinson and Other Degenerative Disease of Basal Ganglia16
- HCC 200 Friedreich and Other Hereditary Ataxias; Huntington Disease17
- HCC 201 Seizure Disorders and Convulsions64
- HCC 202 Coma, Brain Compression/Anoxic Damage61
- HCC 211 Respirator Dependence/Tracheostomy Status/Complications13
- HCC 212 Respiratory Arrest2
- HCC 213 Cardio-Respiratory Failure and Shock36
- HCC 221 Heart Transplant Status/Complications15
- HCC 222 End Stage Heart Failure1
- HCC 223 Heart Assist Device/Artificial Heart6
- HCC 224 Acute on Chronic Heart Failure3
- HCC 225 Acute Heart Failure (Excludes Acute on Chronic)6
- HCC 226 Heart Failure, Except End Stage and Acute34
- HCC 227 Cardiomyopathy/Myocarditis14
- HCC 228 Acute Myocardial Infarction18
- HCC 229 Unstable Angina and Other Acute Ischemic Heart Disease25
- HCC 238 Specified Heart Arrhythmias17
- HCC 248 Intracranial Hemorrhage53
- HCC 249 Ischemic or Unspecified Stroke95
- HCC 253 Hemiplegia/Hemiparesis45
- HCC 254 Monoplegia, Other Paralytic Syndromes119
- HCC 263 Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene127
- HCC 264 Vascular Disease with Complications71
- HCC 267 Deep Vein Thrombosis and Pulmonary Embolism167
- HCC 276 Lung Transplant Status/Complications17
- HCC 277 Cystic Fibrosis5
- HCC 278 Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis4
- HCC 279 Severe Persistent Asthma3
- HCC 280 Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders79
- HCC 282 Aspiration and Specified Bacterial Pneumonias14
- HCC 283 Empyema, Lung Abscess7
- HCC 298 Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage180
- HCC 300 Exudative Macular Degeneration16
- HCC 326 Chronic Kidney Disease, Stage 55
- HCC 327 Chronic Kidney Disease, Severe (Stage 4)1
- HCC 328 Chronic Kidney Disease, Moderate (Stage 3B)1
- HCC 329 Chronic Kidney Disease, Moderate (Stage 3, Except 3B)2
- HCC 379 Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone25
- HCC 380 Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle152
- HCC 381 Pressure Ulcer of Skin with Full Thickness Skin Loss50
- HCC 382 Pressure Ulcer of Skin with Partial Thickness Skin Loss25
- HCC 383 Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle308
- HCC 385 Severe Skin Burn or Condition90
- HCC 387 Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders14
- HCC 397 Major Head Injury with Loss of Consciousness > 1 Hour76
- HCC 398 Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified57
- HCC 399 Major Head Injury without Loss of Consciousness189
- HCC 401 Vertebral Fractures without Spinal Cord Injury339
- HCC 402 Hip Fracture/Dislocation729
- HCC 405 Traumatic Amputations and Complications108
- HCC 409 Amputation Status, Lower Limb/Amputation Complications44
- HCC 454 Stem Cell, Including Bone Marrow, Transplant Status/Complications14
- HCC 463 Artificial Openings for Feeding or Elimination41
Frequently asked questions
What is the CMS-HCC V28 model?
CMS-HCC V28 is the current Hierarchical Condition Category risk adjustment model that CMS uses for Medicare Advantage payment year 2026. Each category groups ICD-10-CM diagnosis codes and has published model and segment coefficients. Those coefficients are references, not a member total.
How many payment categories are in CMS-HCC V28?
The V28 model defines 115 payment HCCs. HCC Buddy lists every category that has at least one payable ICD-10-CM member code, with its member-code count, so you can open the exact category you are coding.
How is an HCC reference coefficient determined?
CMS publishes relative factors by model and enrollment segment, including community Medicaid and originally-disabled status and institutional segments. Open a category to see its source-labeled references. HCC Buddy member score and interaction output remain paused during source review.
Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.