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V28 HCC 37Community non-dual aged RAF 0.166

Diabetes with Chronic Complications

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 37 carries a community non-dual aged RAF of 0.166, and 308 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 35, HCC 36 when a more severe category in the same disease group is also present.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: 0.166Community PBA: 0.166Community FBA: 0.186Community ND: 0.191Community PBD: 0.21Community FBD: 0.235Institutional: 0.28

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 35, HCC 36 (a more severe category in the same disease group supersedes this one).

Supersedes: HCC 38 (this category is counted instead of these when they co-occur).

ICD-10-CM codes that map to HCC 37 (308)

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

Get the V28 RAF + MEAT cheat sheet

A printable one-pager for HCC 37: which member codes risk-adjust, the RAF weight, and the MEAT your notes need to make it stick. Free, no card.

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Frequently asked questions

What is CMS-HCC V28 category 37?

HCC 37 is "Diabetes with Chronic Complications", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 308 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 37?

The community non-dual aged relative factor for CMS-HCC V28 category 37 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 37?

308 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 37 (Diabetes with Chronic Complications) for payment year 2026.

Which categories trump HCC 37 in the V28 hierarchy?

HCC 37 is superseded by HCC 35 (Pancreas Transplant Status), HCC 36 (Diabetes with Severe Acute Complications). When a more severe category in the same disease group is documented, it is counted instead of HCC 37.

Related condition guides

In-depth HCC coding guides for conditions that map to category 37, with documentation tips, common mistakes, and the V24-to-V28 changes.

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.