V28 HCC 78Community non-dual aged RAF 0.326

Intestinal Obstruction/Perforation

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 78 carries a community non-dual aged RAF of 0.326, and 76 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 77 when a more severe category in the same disease group is also present.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: 0.326Community PBA: 0.478Community FBA: 0.382Community ND: 0.534Community PBD: 0.688Community FBD: 0.548Institutional: 0.38

V28 hierarchy

Trumped by: HCC 77 (a more severe category in the same disease group supersedes this one).

ICD-10-CM codes that map to HCC 78 (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.

Frequently asked questions

What is CMS-HCC V28 category 78?

HCC 78 is "Intestinal Obstruction/Perforation", 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 78?

The community non-dual aged relative factor for CMS-HCC V28 category 78 is 0.326. 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 78?

76 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 78 (Intestinal Obstruction/Perforation) for payment year 2026.

Which categories trump HCC 78 in the V28 hierarchy?

HCC 78 is superseded by HCC 77 (Intestine Transplant Status/Complications). When a more severe category in the same disease group is documented, it is counted instead of HCC 78.

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