I08.1
BillableRheumatic disorders of both mitral and tricuspid valves
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I08.1 an HCC code?
No. I08.1 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
I08.1 is the ICD-10-CM diagnosis code for rheumatic disorders of both mitral and tricuspid valves. Damage to both the mitral and tricuspid heart valves caused by rheumatic fever, affecting the heart's ability to pump blood efficiently. I08.1 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering chronic rheumatic heart diseases (i05-i09).
I08.1 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Verify documentation specifies involvement of both mitral and tricuspid valves; if only one valve is affected, use a more specific code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for I08.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies involvement of both mitral and tricuspid valves; if only one valve is affected, use a more specific code
- •Look for evidence of acute rheumatic fever or history of rheumatic fever in the medical record