V28 HCC 38
Diabetes with No, Glycemic, or Unspecified Complications
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 38 has a source-labeled community non-dual aged reference coefficient of 0.166, and 17 ICD-10-CM diagnosis codes appear in its official mapping. In the V28 hierarchy it is superseded by HCC 35, HCC 36, HCC 37 when a more severe category in the same disease group is also present.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.
These are source-labeled code-level HCC coefficient references, not a full member score. Use the RAF Calculator with complete member context for CMS-HCC V28 PY2026. No score is shown unless every required source and calculation check passes.
V28 hierarchy
Trumped by: HCC 35, HCC 36, HCC 37 (a more severe category in the same disease group supersedes this one).
ICD-10-CM codes that map to HCC 38 (17)
ICD-10-CM codes in the official mapping for this category under CMS-HCC V28 PY2026. Open any code for its full description and coding guidance.
- E08.649Diabetes mellitus due to underlying condition with hypoglycemia without coma
- E08.65Diabetes mellitus due to underlying condition with hyperglycemia
- E08.8Diabetes mellitus due to underlying condition with unspecified complications
- E08.9Diabetes mellitus due to underlying condition without complications
- E10.649Type 1 diabetes mellitus with hypoglycemia without coma
- E10.65Type 1 diabetes mellitus with hyperglycemia
- E10.8Type 1 diabetes mellitus with unspecified complications
- E10.9Type 1 diabetes mellitus without complications
- E11.649Type 2 diabetes mellitus with hypoglycemia without coma
- E11.65Type 2 diabetes mellitus with hyperglycemia
- E11.8Type 2 diabetes mellitus with unspecified complications
- E11.9Type 2 diabetes mellitus without complications
- E13.649Other specified diabetes mellitus with hypoglycemia without coma
- E13.65Other specified diabetes mellitus with hyperglycemia
- E13.8Other specified diabetes mellitus with unspecified complications
- E13.9Other specified diabetes mellitus without complications
- Z79.4Long term (current) use of insulin
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 38?
HCC 38 is "Diabetes with No, Glycemic, or Unspecified Complications", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 17 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 38?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 38 is 0.166. The exact coefficient varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 model files.
How many ICD-10-CM codes map to HCC 38?
17 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 38 (Diabetes with No, Glycemic, or Unspecified Complications) for payment year 2026.
Which categories trump HCC 38 in the V28 hierarchy?
HCC 38 is superseded by HCC 35 (Pancreas Transplant Status), HCC 36 (Diabetes with Severe Acute Complications), HCC 37 (Diabetes with Chronic Complications). When a more severe category in the same disease group is documented, it is counted instead of HCC 38.
Related condition guides
In-depth HCC coding guides for conditions that map to category 38, with documentation tips, common mistakes, and the V24-to-V28 changes.
Related references
Sources
CMS ICD-10-CM order-file billability plus the published mapping and 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.