V28 HCC 94Community non-dual aged RAF 0.268

Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 94 carries a community non-dual aged RAF of 0.268, and 71 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 93 when a more severe category in the same disease group is also present.

Medically reviewed by Jess P., CPC · Reviewed: May 30, 2026

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: 0.268Community PBA: 0.224Community FBA: 0.237Community ND: 0.239Community PBD: 0.196Community FBD: 0.25Institutional: 0.297

Combine this factor with demographics and other HCCs in the RAF score calculator to model the full CMS-HCC V28 RAF for a member.

V28 hierarchy

Trumped by: HCC 93 (a more severe category in the same disease group supersedes this one).

ICD-10-CM codes that map to HCC 94 (71)

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.

Coder workflow notes

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Frequently asked questions

What is CMS-HCC V28 category 94?

HCC 94 is "Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 71 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 94?

The community non-dual aged relative factor for CMS-HCC V28 category 94 is 0.268. 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 94?

71 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 94 (Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders) for payment year 2026.

Which categories trump HCC 94 in the V28 hierarchy?

HCC 94 is superseded by HCC 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders). When a more severe category in the same disease group is documented, it is counted instead of HCC 94.

Related references

Sources

CMS published ICD-10-CM mapping file plus 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.