V28 HCC 197
Muscular Dystrophy
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 197 has a source-labeled community non-dual aged reference coefficient of 0.426, and 21 ICD-10-CM diagnosis codes appear in its official mapping.
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.
These are source-labeled code-level HCC coefficient references, not a full member score. Use the RAF Calculator with complete member context for CMS-HCC V28 PY2026. No score is shown unless every required source and calculation check passes.
ICD-10-CM codes that map to HCC 197 (21)
ICD-10-CM codes in the official mapping for this category under CMS-HCC V28 PY2026. Open any code for its full description and coding guidance.
- G71.00Muscular dystrophy, unspecified
- G71.01Duchenne or Becker muscular dystrophy
- G71.02Facioscapulohumeral muscular dystrophy
- G71.031Autosomal dominant limb girdle muscular dystrophy
- G71.032Autosomal recessive limb girdle muscular dystrophy due to calpain-3 dysfunction
- G71.033Limb girdle muscular dystrophy due to dysferlin dysfunction
- G71.0340Limb girdle muscular dystrophy due to sarcoglycan dysfunction, unspecified
- G71.0341Limb girdle muscular dystrophy due to alpha sarcoglycan dysfunction
- G71.0342Limb girdle muscular dystrophy due to beta sarcoglycan dysfunction
- G71.0349Limb girdle muscular dystrophy due to other sarcoglycan dysfunction
- G71.035Limb girdle muscular dystrophy due to anoctamin-5 dysfunction
- G71.036Limb girdle muscular dystrophy due to fukutin related protein dysfunction
- G71.038Other limb girdle muscular dystrophy
- G71.039Limb girdle muscular dystrophy, unspecified
- G71.09Other specified muscular dystrophies
- G71.11Myotonic muscular dystrophy
- G71.20Congenital myopathy, unspecified
- G71.21Nemaline myopathy
- G71.220X-linked myotubular myopathy
- G71.228Other centronuclear myopathy
- G71.29Other congenital myopathy
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 197?
HCC 197 is "Muscular Dystrophy", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 21 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 197?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 197 is 0.426. The exact coefficient varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 model files.
How many ICD-10-CM codes map to HCC 197?
21 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 197 (Muscular Dystrophy) for payment year 2026.
Related references
Sources
CMS ICD-10-CM order-file billability plus the published mapping and 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.