CMS-HCC V28115 payment categories
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.
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 Disorders32
- 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 Disorders19
- 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 Sclerosis20
- 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 to set Medicare Advantage payments. It is at 100 percent phase-in for payment year 2026. Each payment category groups a set of ICD-10-CM diagnosis codes and carries a relative factor (RAF) that contributes to a beneficiary's risk score.
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 the RAF weight for an HCC determined?
Each HCC carries a relative factor published by CMS in the V28 Rate Announcement. The factor varies by enrollment segment (community Medicaid and originally-disabled status, and institutional). Some HCCs also add disease-interaction factors when paired conditions are present. Open a category to see its segment factors.
Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.