Diabetes with Severe Acute Complications
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 36 carries a community non-dual aged RAF of 0.166, and 18 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 35 when a more severe category in the same disease group is also present.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.
V28 hierarchy
Trumped by: HCC 35 (a more severe category in the same disease group supersedes this one).
Supersedes: HCC 37, HCC 38 (this category is counted instead of these when they co-occur).
ICD-10-CM codes that map to HCC 36 (18)
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.
- E08.00Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
- E08.01Diabetes mellitus due to underlying condition with hyperosmolarity with coma
- E08.10Diabetes mellitus due to underlying condition with ketoacidosis without coma
- E08.11Diabetes mellitus due to underlying condition with ketoacidosis with coma
- E08.641Diabetes mellitus due to underlying condition with hypoglycemia with coma
- E10.10Type 1 diabetes mellitus with ketoacidosis without coma
- E10.11Type 1 diabetes mellitus with ketoacidosis with coma
- E10.641Type 1 diabetes mellitus with hypoglycemia with coma
- E11.00Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
- E11.01Type 2 diabetes mellitus with hyperosmolarity with coma
- E11.10Type 2 diabetes mellitus with ketoacidosis without coma
- E11.11Type 2 diabetes mellitus with ketoacidosis with coma
- E11.641Type 2 diabetes mellitus with hypoglycemia with coma
- E13.00Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
- E13.01Other specified diabetes mellitus with hyperosmolarity with coma
- E13.10Other specified diabetes mellitus with ketoacidosis without coma
- E13.11Other specified diabetes mellitus with ketoacidosis with coma
- E13.641Other specified diabetes mellitus with hypoglycemia with coma
Frequently asked questions
What is CMS-HCC V28 category 36?
HCC 36 is "Diabetes with Severe Acute Complications", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 18 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 36?
The community non-dual aged relative factor for CMS-HCC V28 category 36 is 0.166. 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 36?
18 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 36 (Diabetes with Severe Acute Complications) for payment year 2026.
Which categories trump HCC 36 in the V28 hierarchy?
HCC 36 is superseded by HCC 35 (Pancreas Transplant Status). When a more severe category in the same disease group is documented, it is counted instead of HCC 36.
Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.