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V28 HCC 81

Ulcerative Colitis

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 81 has a source-labeled community non-dual aged reference coefficient of 0.244, and 49 ICD-10-CM diagnosis codes appear in its official mapping. In the V28 hierarchy it is superseded by HCC 77, HCC 80 when a more severe category in the same disease group is also present.

By the HCC Buddy Coding Team · Reviewed: May 30, 2026
V28 HCC 81Community non-dual aged reference coefficient 0.244
See ICD-10-CM codes for HCC 81Open the RAF Calculator

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: 0.244Community PBA: 0.205Community FBA: 0.201Community ND: 0.285Community PBD: 0.237Community FBD: 0.286Institutional: 0.258

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 77, HCC 80 (a more severe category in the same disease group supersedes this one).

ICD-10-CM codes that map to HCC 81 (49)

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.

Coder workflow notes

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Frequently asked questions

What is CMS-HCC V28 category 81?

HCC 81 is "Ulcerative Colitis", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 49 ICD-10-CM codes appear in its official mapping.

What reference coefficient is published for HCC 81?

The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 81 is 0.244. 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 81?

49 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 81 (Ulcerative Colitis) for payment year 2026.

Which categories trump HCC 81 in the V28 hierarchy?

HCC 81 is superseded by HCC 77 (Intestine Transplant Status/Complications), HCC 80 (Crohn's Disease (Regional Enteritis)). When a more severe category in the same disease group is documented, it is counted instead of HCC 81.

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.