V28 HCC 264Community non-dual aged RAF 0.455

Vascular Disease with Complications

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 264 carries a community non-dual aged RAF of 0.455, and 71 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 263 when a more severe category in the same disease group is also present.

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: 0.455Community PBA: 0.513Community FBA: 0.498Community ND: 0.52Community PBD: 0.622Community FBD: 0.461Institutional: 0.338

V28 hierarchy

Trumped by: HCC 263 (a more severe category in the same disease group supersedes this one).

ICD-10-CM codes that map to HCC 264 (71)

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 264?

HCC 264 is "Vascular Disease with Complications", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 71 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 264?

The community non-dual aged relative factor for CMS-HCC V28 category 264 is 0.455. 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 264?

71 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 264 (Vascular Disease with Complications) for payment year 2026.

Which categories trump HCC 264 in the V28 hierarchy?

HCC 264 is superseded by HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene). When a more severe category in the same disease group is documented, it is counted instead of HCC 264.

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