V28 HCC 197Community non-dual aged RAF 0.426

Muscular Dystrophy

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 197 carries a community non-dual aged RAF of 0.426, and 21 payable ICD-10-CM diagnosis codes map to it.

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.

Community NA: 0.426Community PBA: 0.162Community FBA: 0.369Community ND: 0.632Community PBD: 0.145Community FBD: 0.681Institutional: 0.292

ICD-10-CM codes that map to HCC 197 (21)

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.

Frequently asked questions

What is CMS-HCC V28 category 197?

HCC 197 is "Muscular Dystrophy", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 21 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 197?

The community non-dual aged relative factor for CMS-HCC V28 category 197 is 0.426. 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 197?

21 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 197 (Muscular Dystrophy) for payment year 2026.

Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.