V28 HCC 254Community non-dual aged RAF 0.321

Monoplegia, Other Paralytic Syndromes

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 254 carries a community non-dual aged RAF of 0.321, and 119 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 180, HCC 181, HCC 191, HCC 192, HCC 253 when a more severe category in the same disease group is also present.

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.

Community NA: 0.321Community PBA: 0.29Community FBA: 0.292Community ND: 0.172Community PBD: 0.335Community FBD: 0.365Institutional: 0

Combine this factor with demographics and other HCCs in the RAF score calculator to model the full CMS-HCC V28 RAF for a member.

V28 hierarchy

Trumped by: HCC 180, HCC 181, HCC 191, HCC 192, HCC 253 (a more severe category in the same disease group supersedes this one).

ICD-10-CM codes that map to HCC 254 (119)

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.

Coder workflow notes

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Frequently asked questions

What is CMS-HCC V28 category 254?

HCC 254 is "Monoplegia, Other Paralytic Syndromes", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 119 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 254?

The community non-dual aged relative factor for CMS-HCC V28 category 254 is 0.321. 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 254?

119 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 254 (Monoplegia, Other Paralytic Syndromes) for payment year 2026.

Which categories trump HCC 254 in the V28 hierarchy?

HCC 254 is superseded by HCC 180 (Quadriplegia), HCC 181 (Paraplegia), HCC 191 (Quadriplegic Cerebral Palsy), HCC 192 (Cerebral Palsy, Except Quadriplegic), HCC 253 (Hemiplegia/Hemiparesis). When a more severe category in the same disease group is documented, it is counted instead of HCC 254.

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.