V28 HCC 409
Amputation Status, Lower Limb/Amputation Complications
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 409 has a source-labeled community non-dual aged reference coefficient of 0.598, and 44 ICD-10-CM diagnosis codes appear in its official mapping. In the V28 hierarchy it is superseded by HCC 263, HCC 405 when a more severe category in the same disease group is also present.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 263, HCC 405 (a more severe category in the same disease group supersedes this one).
ICD-10-CM codes that map to HCC 409 (44)
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.
- G54.6Phantom limb syndrome with pain
- G54.7Phantom limb syndrome without pain
- T87.30Neuroma of amputation stump, unspecified extremity
- T87.31Neuroma of amputation stump, right upper extremity
- T87.32Neuroma of amputation stump, left upper extremity
- T87.33Neuroma of amputation stump, right lower extremity
- T87.34Neuroma of amputation stump, left lower extremity
- T87.40Infection of amputation stump, unspecified extremity
- T87.41Infection of amputation stump, right upper extremity
- T87.42Infection of amputation stump, left upper extremity
- T87.43Infection of amputation stump, right lower extremity
- T87.44Infection of amputation stump, left lower extremity
- T87.50Necrosis of amputation stump, unspecified extremity
- T87.51Necrosis of amputation stump, right upper extremity
- T87.52Necrosis of amputation stump, left upper extremity
- T87.53Necrosis of amputation stump, right lower extremity
- T87.54Necrosis of amputation stump, left lower extremity
- T87.81Dehiscence of amputation stump
- T87.89Other complications of amputation stump
- T87.9Unspecified complications of amputation stump
- Z44.101Encounter for fitting and adjustment of unspecified right artificial leg
- Z44.102Encounter for fitting and adjustment of unspecified left artificial leg
- Z44.109Encounter for fitting and adjustment of unspecified artificial leg, unspecified leg
- Z44.111Encounter for fitting and adjustment of complete right artificial leg
- Z44.112Encounter for fitting and adjustment of complete left artificial leg
- Z44.119Encounter for fitting and adjustment of complete artificial leg, unspecified leg
- Z44.121Encounter for fitting and adjustment of partial artificial right leg
- Z44.122Encounter for fitting and adjustment of partial artificial left leg
- Z44.129Encounter for fitting and adjustment of partial artificial leg, unspecified leg
- Z89.431Acquired absence of right foot
- Z89.432Acquired absence of left foot
- Z89.439Acquired absence of unspecified foot
- Z89.441Acquired absence of right ankle
- Z89.442Acquired absence of left ankle
- Z89.449Acquired absence of unspecified ankle
- Z89.511Acquired absence of right leg below knee
- Z89.512Acquired absence of left leg below knee
- Z89.519Acquired absence of unspecified leg below knee
- Z89.611Acquired absence of right leg above knee
- Z89.612Acquired absence of left leg above knee
- Z89.619Acquired absence of unspecified leg above knee
- Z97.13Presence of artificial right leg (complete) (partial)
- Z97.14Presence of artificial left leg (complete) (partial)
- Z97.16Presence of artificial legs, bilateral (complete) (partial)
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 409?
HCC 409 is "Amputation Status, Lower Limb/Amputation Complications", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 44 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 409?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 409 is 0.598. 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 409?
44 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 409 (Amputation Status, Lower Limb/Amputation Complications) for payment year 2026.
Which categories trump HCC 409 in the V28 hierarchy?
HCC 409 is superseded by HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene), HCC 405 (Traumatic Amputations and Complications). When a more severe category in the same disease group is documented, it is counted instead of HCC 409.
Related condition guides
In-depth HCC coding guides for conditions that map to category 409, 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.