Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 109 carries a community non-dual aged RAF of 1.144, and 37 payable ICD-10-CM diagnosis codes map to it.
Medically reviewed by Jess P., CPC · Reviewed: May 30, 2026
RAF factors
The community factor varies by Medicaid and originally-disabled status; the institutional factor applies to long-term-institutional members. These are the CMS-HCC V28 PY2026 relative factors.
Combine this factor with demographics and other HCCs in the RAF score calculator to model the full CMS-HCC V28 RAF for a member.
ICD-10-CM codes that map to HCC 109 (37)
Payable diagnosis codes that map to this category under CMS-HCC V28 PY2026. Open any code for its full description, HCC mapping, and coding guidance.
- D59.10Autoimmune hemolytic anemia, unspecified
- D59.11Warm autoimmune hemolytic anemia
- D59.12Cold autoimmune hemolytic anemia
- D59.13Mixed type autoimmune hemolytic anemia
- D59.19Other autoimmune hemolytic anemia
- D59.30Hemolytic-uremic syndrome, unspecified
- D59.31Infection-associated hemolytic-uremic syndrome
- D59.32Hereditary hemolytic-uremic syndrome
- D59.39Other hemolytic-uremic syndrome
- D59.4Other nonautoimmune hemolytic anemias
- D59.5Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]
- D59.6Hemoglobinuria due to hemolysis from other external causes
- D59.8Other acquired hemolytic anemias
- D59.9Acquired hemolytic anemia, unspecified
- D60.0Chronic acquired pure red cell aplasia
- D60.8Other acquired pure red cell aplasias
- D60.9Acquired pure red cell aplasia, unspecified
- D61.01Constitutional (pure) red blood cell aplasia
- D61.02Shwachman-Diamond syndrome
- D61.03Fanconi anemia
- D61.09Other constitutional aplastic anemia
- D61.2Aplastic anemia due to other external agents
- D61.3Idiopathic aplastic anemia
- D61.818Other pancytopenia
- D61.82Myelophthisis
- D61.89Other specified aplastic anemias and other bone marrow failure syndromes
- D64.0Hereditary sideroblastic anemia
- D64.1Secondary sideroblastic anemia due to disease
- D64.3Other sideroblastic anemias
- D64.4Congenital dyserythropoietic anemia
- P55.0Rh isoimmunization of newborn
- P55.1ABO isoimmunization of newborn
- P55.8Other hemolytic diseases of newborn
- P55.9Hemolytic disease of newborn, unspecified
- P56.0Hydrops fetalis due to isoimmunization
- P56.90Hydrops fetalis due to unspecified hemolytic disease
- P56.99Hydrops fetalis due to other hemolytic disease
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 109?
HCC 109 is "Acquired Hemolytic, Aplastic, and Sideroblastic Anemias", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 37 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 109?
The community non-dual aged relative factor for CMS-HCC V28 category 109 is 1.144. The exact factor varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 Rate Announcement.
How many ICD-10-CM codes map to HCC 109?
37 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias) for payment year 2026.
Related references
Sources
CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software. CMS-HCC V28 model published at CMS.gov Risk Adjustors; ICD-10-CM member codes from the CMS ICD-10-CM code set.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 30, 2026.