V28 HCC 381Community non-dual aged RAF 1.075

Pressure Ulcer of Skin with Full Thickness Skin Loss

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 381 carries a community non-dual aged RAF of 1.075, and 50 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 379, HCC 380 when a more severe category in the same disease group is also present.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: 1.075Community PBA: 1.136Community FBA: 1.379Community ND: 1.091Community PBD: 1.089Community FBD: 1.192Institutional: 0.423

V28 hierarchy

Trumped by: HCC 379, HCC 380 (a more severe category in the same disease group supersedes this one).

Supersedes: HCC 382, HCC 383 (this category is counted instead of these when they co-occur).

ICD-10-CM codes that map to HCC 381 (50)

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 381?

HCC 381 is "Pressure Ulcer of Skin with Full Thickness Skin Loss", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 50 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 381?

The community non-dual aged relative factor for CMS-HCC V28 category 381 is 1.075. 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 381?

50 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 381 (Pressure Ulcer of Skin with Full Thickness Skin Loss) for payment year 2026.

Which categories trump HCC 381 in the V28 hierarchy?

HCC 381 is superseded by HCC 379 (Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone), HCC 380 (Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle). When a more severe category in the same disease group is documented, it is counted instead of HCC 381.

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