V28 HCC 397Community non-dual aged RAF 0.199
Major Head Injury with Loss of Consciousness > 1 Hour
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 397 carries a community non-dual aged RAF of 0.199, and 76 payable ICD-10-CM diagnosis codes map to it.
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: 0.199Community PBA: 0.128Community FBA: 0.349Community ND: 0.15Community PBD: 0.052Community FBD: 0.19Institutional: 0.085
V28 hierarchy
Supersedes: HCC 202, HCC 398, HCC 399 (this category is counted instead of these when they co-occur).
ICD-10-CM codes that map to HCC 397 (76)
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.
- S06.1X3ATraumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.1X4ATraumatic cerebral edema with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.1X5ATraumatic cerebral edema with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.1X6ATraumatic cerebral edema with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.2X3ADiffuse traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.2X4ADiffuse traumatic brain injury with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.2X5ADiffuse traumatic brain injury with loss of consciousness greater than 24 hours with return to pre-existing conscious levels, initial encounter
- S06.2X6ADiffuse traumatic brain injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.303AUnspecified focal traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.304AUnspecified focal traumatic brain injury with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.305AUnspecified focal traumatic brain injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.306AUnspecified focal traumatic brain injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.313AContusion and laceration of right cerebrum with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.314AContusion and laceration of right cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.315AContusion and laceration of right cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.316AContusion and laceration of right cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.323AContusion and laceration of left cerebrum with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.324AContusion and laceration of left cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.325AContusion and laceration of left cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.326AContusion and laceration of left cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.333AContusion and laceration of cerebrum, unspecified, with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.334AContusion and laceration of cerebrum, unspecified, with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.335AContusion and laceration of cerebrum, unspecified, with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.336AContusion and laceration of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.343ATraumatic hemorrhage of right cerebrum with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter
- S06.344ATraumatic hemorrhage of right cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.345ATraumatic hemorrhage of right cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.346ATraumatic hemorrhage of right cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.353ATraumatic hemorrhage of left cerebrum with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter
- S06.354ATraumatic hemorrhage of left cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.355ATraumatic hemorrhage of left cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.356ATraumatic hemorrhage of left cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.363ATraumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter
- S06.364ATraumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.365ATraumatic hemorrhage of cerebrum, unspecified, with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.366ATraumatic hemorrhage of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.373AContusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.374AContusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.375AContusion, laceration, and hemorrhage of cerebellum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.376AContusion, laceration, and hemorrhage of cerebellum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.383AContusion, laceration, and hemorrhage of brainstem with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.384AContusion, laceration, and hemorrhage of brainstem with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.385AContusion, laceration, and hemorrhage of brainstem with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.386AContusion, laceration, and hemorrhage of brainstem with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.4X3AEpidural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.4X4AEpidural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.4X5AEpidural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.4X6AEpidural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.5X3ATraumatic subdural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.5X4ATraumatic subdural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.5X5ATraumatic subdural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.5X6ATraumatic subdural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.6X3ATraumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.6X4ATraumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.6X5ATraumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.6X6ATraumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.813AInjury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.814AInjury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.815AInjury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.816AInjury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.823AInjury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.824AInjury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.825AInjury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.826AInjury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.893AOther specified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.894AOther specified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.895AOther specified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.896AOther specified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.8A3APrimary blast injury of brain, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.8A4APrimary blast injury of brain, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.8A5APrimary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.8A6APrimary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
- S06.9X3AUnspecified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
- S06.9X4AUnspecified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial encounter
- S06.9X5AUnspecified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
- S06.9X6AUnspecified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
Frequently asked questions
What is CMS-HCC V28 category 397?
HCC 397 is "Major Head Injury with Loss of Consciousness > 1 Hour", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 76 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 397?
The community non-dual aged relative factor for CMS-HCC V28 category 397 is 0.199. 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 397?
76 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 397 (Major Head Injury with Loss of Consciousness > 1 Hour) for payment year 2026.
Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.