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V28 HCC 38Community non-dual aged RAF 0.166

Diabetes with No, Glycemic, or Unspecified Complications

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 38 carries a community non-dual aged RAF of 0.166, and 17 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 35, HCC 36, HCC 37 when a more severe category in the same disease group is also present.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.

Community NA: 0.166Community PBA: 0.166Community FBA: 0.186Community ND: 0.191Community PBD: 0.21Community FBD: 0.235Institutional: 0.28

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)

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 38?

HCC 38 is "Diabetes with No, Glycemic, or Unspecified Complications", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 17 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 38?

The community non-dual aged relative factor for CMS-HCC V28 category 38 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 38?

17 payable ICD-10-CM diagnosis codes map to 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HCC 38 is superseded by HCC 35 (Pancreas Transplant Status), HCC 36 (Diabetes with Severe Acute Complications), HCC 37 (Diabetes with Chronic Complications).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.

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