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HCC 107: Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero

HCC 107, Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero, is one of the 115 payment categories in the CMS-HCC V28 model. 14 ICD-10-CM codes map to it in the payment year 2027 mapping, and a documented diagnosis in the category adds a relative factor of 0.457 to the risk score of a community, non-dual, aged beneficiary (1.449 disabled, 0.692 institutional). It sits at the top of its hierarchy, so no other category overrides it and it in turn overrides HCC 108.

QuickIntell editorial content · Legacy registry date · Review not verified

Data effective
Data currency: ICD-10-CM to HCC mapping PY2027 initial (effective dates of service 2026, payment year 2027); CMS-HCC V28 model software V2826.115.T2 (effective payment year 2027). Next CMS release: PY2027 midyear final mapping (spring 2027) and PY2028 proposed model (February 2027).
Mapped ICD-10-CM codes
14
Factor, community non-dual aged
0.457
Factor, institutional
0.692
Hierarchy
Top of hierarchy
Disease group
Blood

Relative factors by segment

Each segment is a separate regression; the factor is added to the beneficiary's demographic factors and other categories, then normalized and reduced by the coding intensity adjustment before it meets the plan's base rate. A factor of 1.000 equals the expected cost of an average beneficiary.

CMS-HCC V28 relative factors for HCC 107 by model segment
SegmentModel codeRelative factor
Community, non-dual, agedCNA_HCC1070.457
Community, non-dual, disabledCND_HCC1071.449
Community, full-benefit dual, agedCFA_HCC1070.610
Community, full-benefit dual, disabledCFD_HCC1071.939
Community, partial-benefit dual, agedCPA_HCC1070.303
Community, partial-benefit dual, disabledCPD_HCC1071.569
Long-term institutionalINS_HCC1070.692

Hierarchy

Hierarchical condition categories pay only the most severe manifestation of a disease. HCC 107 is the most severe category in its hierarchy. When HCC 107 is present it drops HCC 108 (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major), so documenting the less severe condition alongside it adds nothing to payment but still matters for the clinical record.

HCC 108
Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major · 39 codes · factor 0.146

ICD-10-CM codes that map to HCC 107

14 codes map to this category in the PY2027 initial mapping. Descriptions are the CMS mapping descriptions for the FY2026 code set; a code that is deleted or split in the October code update stays valid for dates of service before the change.

ICD-10-CM codes mapped to HCC 107 in the CMS PY2027 initial mapping
ICD-10-CMDescription
D5700Hb-SS disease with crisis, unspecified
D5701Hb-SS disease with acute chest syndrome
D5702Hb-SS disease with splenic sequestration
D5703Hb-SS disease with cerebral vascular involvement
D5704Hb-SS disease with dactylitis
D5709Hb-SS disease with crisis with other specified complication
D571Sickle-cell disease without crisis
D5742Sickle-cell thalassemia beta zero without crisis
D57431Sickle-cell thalassemia beta zero with acute chest syndrome
D57432Sickle-cell thalassemia beta zero with splenic sequestration
D57433Sickle-cell thalassemia beta zero with cerebral vascular involvement
D57434Sickle-cell thalassemia beta zero with dactylitis
D57438Sickle-cell thalassemia beta zero with crisis with other specified complication
D57439Sickle-cell thalassemia beta zero with crisis, unspecified

Where these codes sat in the V22 model

The V28 recalibration renumbered and regrouped categories; this table shows which legacy V22 categories the same ICD-10 codes belonged to, which is the quickest way to reconcile a V22-era HCC gap list with the current model.

V22 categories that the HCC 107 codes mapped to
V22 HCCCodes
4614

Capturing and defending the category

A category counts for a payment year when a mapped diagnosis is documented at least once during the data collection year by an acceptable provider type at a face-to-face or audio-video encounter, and when the note shows the condition was monitored, evaluated, assessed or treated. Chronic conditions do not carry forward: a category that is not re-documented in the year drops out of the score, which is why annual wellness visits and problem-list reconciliation are where most recapture happens. Risk adjustment data validation audits sample enrollees and ask for the medical record behind each submitted category; an unsupported category is removed and, under the extrapolation rules, the error rate is applied across the contract. The QuickIntell risk adjustment product surfaces suspected and unsupported categories from the chart, and the HCC hub lists every V28 category with its factor and code count.

Frequently asked questions

Which ICD-10 codes map to HCC 107?

14 ICD-10-CM codes map to HCC 107 in the CMS PY2027 initial mapping, for example D5700 Hb-SS disease with crisis, unspecified; D5701 Hb-SS disease with acute chest syndrome; D5702 Hb-SS disease with splenic sequestration; D5703 Hb-SS disease with cerebral vascular involvement. The full list is on this page; a code counts only when it is documented at a face-to-face or video encounter in the data collection year and supported by the record.

How much does HCC 107 add to a risk score?

The V28 relative factor for HCC 107 is 0.457 for a community, non-dual, aged beneficiary, 0.610 for full-benefit dual aged, 1.449 for non-dual disabled and 0.692 for long-term institutional members. A factor of 1.000 equals the expected annual cost of an average beneficiary, so the category's share of the payment follows the plan's base rate for that segment.

Does HCC 107 count together with related categories?

No. Within a hierarchy only the most severe category is paid. HCC 107 is the most severe category in its hierarchy, and it drops HCC 108 when it is present.

What has to be documented for HCC 107 to be valid?

The diagnosis must be recorded by an acceptable provider type during a face-to-face or audio-video encounter in the service year, with the note showing that the condition was monitored, evaluated, assessed or treated. Risk adjustment data validation audits recover payment for categories the record does not support, so the code on the claim and the assessment in the note must match.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

Relative factors and mappings are reproduced from the CMS risk adjustment model files as an operational reference. Payment depends on the plan's base rate, normalization, the coding intensity adjustment and the enrollee's segment. Not legal, clinical or billing advice.