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.
| Segment | Model code | Relative factor |
|---|---|---|
| Community, non-dual, aged | CNA_HCC155 | 0.299 |
| Community, non-dual, disabled | CND_HCC155 | 0.166 |
| Community, full-benefit dual, aged | CFA_HCC155 | 0.316 |
| Community, full-benefit dual, disabled | CFD_HCC155 | 0.126 |
| Community, partial-benefit dual, aged | CPA_HCC155 | 0.269 |
| Community, partial-benefit dual, disabled | CPD_HCC155 | 0.108 |
| Long-term institutional | INS_HCC155 | 0.199 |
Hierarchy
Hierarchical condition categories pay only the most severe manifestation of a disease. When HCC 151 (Schizophrenia) or HCC 152 (Psychosis, Except Schizophrenia) or HCC 153 (Personality Disorders; Anorexia/Bulimia Nervosa) or HCC 154 (Bipolar Disorders without Psychosis) is also documented for the same beneficiary, HCC 155 is dropped from the score.
ICD-10-CM codes that map to HCC 155
371 codes map to this category in the PY2027 initial mapping, concentrated in the T63 (38), T43 (20), T50 (19), T40 (15), T45 (15), T65 (15) code families. 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 | Description |
|---|---|
| F321 | Major depressive disorder, single episode, moderate |
| F322 | Major depressive disorder, single episode, severe without psychotic features |
| F331 | Major depressive disorder, recurrent, moderate |
| F332 | Major depressive disorder, recurrent severe without psychotic features |
| R4588 | Nonsuicidal self-harm |
| T1491XA | Suicide attempt, initial encounter |
| T360X2A | Poisoning by penicillins, intentional self-harm, initial encounter |
| T361X2A | Poisoning by cephalosporins and other beta-lactam antibiotics, intentional self-harm, initial encounter |
| T362X2A | Poisoning by chloramphenicol group, intentional self-harm, initial encounter |
| T363X2A | Poisoning by macrolides, intentional self-harm, initial encounter |
| T364X2A | Poisoning by tetracyclines, intentional self-harm, initial encounter |
| T365X2A | Poisoning by aminoglycosides, intentional self-harm, initial encounter |
| T366X2A | Poisoning by rifampicins, intentional self-harm, initial encounter |
| T367X2A | Poisoning by antifungal antibiotics, systemically used, intentional self-harm, initial encounter |
| T368X2A | Poisoning by other systemic antibiotics, intentional self-harm, initial encounter |
| T3692XA | Poisoning by unspecified systemic antibiotic, intentional self-harm, initial encounter |
| T36AX2A | Poisoning by fluoroquinolone antibiotics, intentional self-harm, initial encounter |
| T370X2A | Poisoning by sulfonamides, intentional self-harm, initial encounter |
| T371X2A | Poisoning by antimycobacterial drugs, intentional self-harm, initial encounter |
| T372X2A | Poisoning by antimalarials and drugs acting on other blood protozoa, intentional self-harm, initial encounter |
| T373X2A | Poisoning by other antiprotozoal drugs, intentional self-harm, initial encounter |
| T374X2A | Poisoning by anthelminthics, intentional self-harm, initial encounter |
| T375X2A | Poisoning by antiviral drugs, intentional self-harm, initial encounter |
| T378X2A | Poisoning by other specified systemic anti-infectives and antiparasitics, intentional self-harm, initial encounter |
| T3792XA | Poisoning by unspecified systemic anti-infective and antiparasitics, intentional self-harm, initial encounter |
| T380X2A | Poisoning by glucocorticoids and synthetic analogues, intentional self-harm, initial encounter |
| T381X2A | Poisoning by thyroid hormones and substitutes, intentional self-harm, initial encounter |
| T382X2A | Poisoning by antithyroid drugs, intentional self-harm, initial encounter |
| T383X2A | Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, intentional self-harm, initial encounter |
| T384X2A | Poisoning by oral contraceptives, intentional self-harm, initial encounter |
| T385X2A | Poisoning by other estrogens and progestogens, intentional self-harm, initial encounter |
| T386X2A | Poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, intentional self-harm, initial encounter |
| T387X2A | Poisoning by androgens and anabolic congeners, intentional self-harm, initial encounter |
| T38802A | Poisoning by unspecified hormones and synthetic substitutes, intentional self-harm, initial encounter |
| T38812A | Poisoning by anterior pituitary [adenohypophyseal] hormones, intentional self-harm, initial encounter |
| T38892A | Poisoning by other hormones and synthetic substitutes, intentional self-harm, initial encounter |
| T38902A | Poisoning by unspecified hormone antagonists, intentional self-harm, initial encounter |
| T38992A | Poisoning by other hormone antagonists, intentional self-harm, initial encounter |
| T39012A | Poisoning by aspirin, intentional self-harm, initial encounter |
| T39092A | Poisoning by salicylates, intentional self-harm, initial encounter |
| T391X2A | Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter |
| T392X2A | Poisoning by pyrazolone derivatives, intentional self-harm, initial encounter |
| T39312A | Poisoning by propionic acid derivatives, intentional self-harm, initial encounter |
| T39392A | Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional self-harm, initial encounter |
| T394X2A | Poisoning by antirheumatics, not elsewhere classified, intentional self-harm, initial encounter |
| T398X2A | Poisoning by other nonopioid analgesics and antipyretics, not elsewhere classified, intentional self-harm, initial encounter |
| T3992XA | Poisoning by unspecified nonopioid analgesic, antipyretic and antirheumatic, intentional self-harm, initial encounter |
| T400X2A | Poisoning by opium, intentional self-harm, initial encounter |
| T401X2A | Poisoning by heroin, intentional self-harm, initial encounter |
| T402X2A | Poisoning by other opioids, intentional self-harm, initial encounter |
| T403X2A | Poisoning by methadone, intentional self-harm, initial encounter |
| T40412A | Poisoning by fentanyl or fentanyl analogs, intentional self-harm, initial encounter |
| T40422A | Poisoning by tramadol, intentional self-harm, initial encounter |
| T40492A | Poisoning by other synthetic narcotics, intentional self-harm, initial encounter |
| T405X2A | Poisoning by cocaine, intentional self-harm, initial encounter |
| T40602A | Poisoning by unspecified narcotics, intentional self-harm, initial encounter |
| T40692A | Poisoning by other narcotics, intentional self-harm, initial encounter |
| T40712A | Poisoning by cannabis, intentional self-harm, initial encounter |
| T40722A | Poisoning by synthetic cannabinoids, intentional self-harm, initial encounter |
| T408X2A | Poisoning by lysergide [LSD], intentional self-harm, initial encounter |
| T40902A | Poisoning by unspecified psychodysleptics [hallucinogens], intentional self-harm, initial encounter |
| T40992A | Poisoning by other psychodysleptics [hallucinogens], intentional self-harm, initial encounter |
| T410X2A | Poisoning by inhaled anesthetics, intentional self-harm, initial encounter |
| T411X2A | Poisoning by intravenous anesthetics, intentional self-harm, initial encounter |
| T41202A | Poisoning by unspecified general anesthetics, intentional self-harm, initial encounter |
| T41292A | Poisoning by other general anesthetics, intentional self-harm, initial encounter |
| T413X2A | Poisoning by local anesthetics, intentional self-harm, initial encounter |
| T4142XA | Poisoning by unspecified anesthetic, intentional self-harm, initial encounter |
| T415X2A | Poisoning by therapeutic gases, intentional self-harm, initial encounter |
| T420X2A | Poisoning by hydantoin derivatives, intentional self-harm, initial encounter |
| T421X2A | Poisoning by iminostilbenes, intentional self-harm, initial encounter |
| T422X2A | Poisoning by succinimides and oxazolidinediones, intentional self-harm, initial encounter |
| T423X2A | Poisoning by barbiturates, intentional self-harm, initial encounter |
| T424X2A | Poisoning by benzodiazepines, intentional self-harm, initial encounter |
| T425X2A | Poisoning by mixed antiepileptics, intentional self-harm, initial encounter |
| T426X2A | Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter |
| T4272XA | Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter |
| T428X2A | Poisoning by antiparkinsonism drugs and other central muscle-tone depressants, intentional self-harm, initial encounter |
| T43012A | Poisoning by tricyclic antidepressants, intentional self-harm, initial encounter |
| T43022A | Poisoning by tetracyclic antidepressants, intentional self-harm, initial encounter |
| T431X2A | Poisoning by monoamine-oxidase-inhibitor antidepressants, intentional self-harm, initial encounter |
| T43202A | Poisoning by unspecified antidepressants, intentional self-harm, initial encounter |
| T43212A | Poisoning by selective serotonin and norepinephrine reuptake inhibitors, intentional self-harm, initial encounter |
| T43222A | Poisoning by selective serotonin reuptake inhibitors, intentional self-harm, initial encounter |
| T43292A | Poisoning by other antidepressants, intentional self-harm, initial encounter |
| T433X2A | Poisoning by phenothiazine antipsychotics and neuroleptics, intentional self-harm, initial encounter |
| T434X2A | Poisoning by butyrophenone and thiothixene neuroleptics, intentional self-harm, initial encounter |
| T43502A | Poisoning by unspecified antipsychotics and neuroleptics, intentional self-harm, initial encounter |
| T43592A | Poisoning by other antipsychotics and neuroleptics, intentional self-harm, initial encounter |
| T43602A | Poisoning by unspecified psychostimulants, intentional self-harm, initial encounter |
| T43612A | Poisoning by caffeine, intentional self-harm, initial encounter |
| T43622A | Poisoning by amphetamines, intentional self-harm, initial encounter |
| T43632A | Poisoning by methylphenidate, intentional self-harm, initial encounter |
| T43642A | Poisoning by ecstasy, intentional self-harm, initial encounter |
| T43652A | Poisoning by methamphetamines intentional self-harm, initial encounter |
| T43692A | Poisoning by other psychostimulants, intentional self-harm, initial encounter |
| T438X2A | Poisoning by other psychotropic drugs, intentional self-harm, initial encounter |
| T4392XA | Poisoning by unspecified psychotropic drug, intentional self-harm, initial encounter |
| T440X2A | Poisoning by anticholinesterase agents, intentional self-harm, initial encounter |
| T441X2A | Poisoning by other parasympathomimetics [cholinergics], intentional self-harm, initial encounter |
| T442X2A | Poisoning by ganglionic blocking drugs, intentional self-harm, initial encounter |
| T443X2A | Poisoning by other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, intentional self-harm, initial encounter |
| T444X2A | Poisoning by predominantly alpha-adrenoreceptor agonists, intentional self-harm, initial encounter |
| T445X2A | Poisoning by predominantly beta-adrenoreceptor agonists, intentional self-harm, initial encounter |
| T446X2A | Poisoning by alpha-adrenoreceptor antagonists, intentional self-harm, initial encounter |
| T447X2A | Poisoning by beta-adrenoreceptor antagonists, intentional self-harm, initial encounter |
| T448X2A | Poisoning by centrally-acting and adrenergic-neuron-blocking agents, intentional self-harm, initial encounter |
| T44902A | Poisoning by unspecified drugs primarily affecting the autonomic nervous system, intentional self-harm, initial encounter |
| T44992A | Poisoning by other drug primarily affecting the autonomic nervous system, intentional self-harm, initial encounter |
| T450X2A | Poisoning by antiallergic and antiemetic drugs, intentional self-harm, initial encounter |
| T451X2A | Poisoning by antineoplastic and immunosuppressive drugs, intentional self-harm, initial encounter |
| T452X2A | Poisoning by vitamins, intentional self-harm, initial encounter |
| T453X2A | Poisoning by enzymes, intentional self-harm, initial encounter |
| T454X2A | Poisoning by iron and its compounds, intentional self-harm, initial encounter |
| T45512A | Poisoning by anticoagulants, intentional self-harm, initial encounter |
| T45522A | Poisoning by antithrombotic drugs, intentional self-harm, initial encounter |
| T45602A | Poisoning by unspecified fibrinolysis-affecting drugs, intentional self-harm, initial encounter |
| T45612A | Poisoning by thrombolytic drug, intentional self-harm, initial encounter |
| T45622A | Poisoning by hemostatic drug, intentional self-harm, initial encounter |
| T45692A | Poisoning by other fibrinolysis-affecting drugs, intentional self-harm, initial encounter |
| T457X2A | Poisoning by anticoagulant antagonists, vitamin K and other coagulants, intentional self-harm, initial encounter |
| T458X2A | Poisoning by other primarily systemic and hematological agents, intentional self-harm, initial encounter |
| T4592XA | Poisoning by unspecified primarily systemic and hematological agent, intentional self-harm, initial encounter |
| T45AX2A | Poisoning by immune checkpoint inhibitors and immunostimulant drugs, intentional self-harm, initial encounter |
| T460X2A | Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm, initial encounter |
| T461X2A | Poisoning by calcium-channel blockers, intentional self-harm, initial encounter |
| T462X2A | Poisoning by other antidysrhythmic drugs, intentional self-harm, initial encounter |
| T463X2A | Poisoning by coronary vasodilators, intentional self-harm, initial encounter |
| T464X2A | Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm, initial encounter |
| T465X2A | Poisoning by other antihypertensive drugs, intentional self-harm, initial encounter |
| T466X2A | Poisoning by antihyperlipidemic and antiarteriosclerotic drugs, intentional self-harm, initial encounter |
| T467X2A | Poisoning by peripheral vasodilators, intentional self-harm, initial encounter |
| T468X2A | Poisoning by antivaricose drugs, including sclerosing agents, intentional self-harm, initial encounter |
| T46902A | Poisoning by unspecified agents primarily affecting the cardiovascular system, intentional self-harm, initial encounter |
| T46992A | Poisoning by other agents primarily affecting the cardiovascular system, intentional self-harm, initial encounter |
| T470X2A | Poisoning by histamine H2-receptor blockers, intentional self-harm, initial encounter |
| T471X2A | Poisoning by other antacids and anti-gastric-secretion drugs, intentional self-harm, initial encounter |
| T472X2A | Poisoning by stimulant laxatives, intentional self-harm, initial encounter |
| T473X2A | Poisoning by saline and osmotic laxatives, intentional self-harm, initial encounter |
| T474X2A | Poisoning by other laxatives, intentional self-harm, initial encounter |
| T475X2A | Poisoning by digestants, intentional self-harm, initial encounter |
| T476X2A | Poisoning by antidiarrheal drugs, intentional self-harm, initial encounter |
| T477X2A | Poisoning by emetics, intentional self-harm, initial encounter |
| T478X2A | Poisoning by other agents primarily affecting gastrointestinal system, intentional self-harm, initial encounter |
| T4792XA | Poisoning by unspecified agents primarily affecting the gastrointestinal system, intentional self-harm, initial encounter |
| T480X2A | Poisoning by oxytocic drugs, intentional self-harm, initial encounter |
| T481X2A | Poisoning by skeletal muscle relaxants [neuromuscular blocking agents], intentional self-harm, initial encounter |
| T48202A | Poisoning by unspecified drugs acting on muscles, intentional self-harm, initial encounter |
| T48292A | Poisoning by other drugs acting on muscles, intentional self-harm, initial encounter |
| T483X2A | Poisoning by antitussives, intentional self-harm, initial encounter |
| T484X2A | Poisoning by expectorants, intentional self-harm, initial encounter |
| T485X2A | Poisoning by other anti-common-cold drugs, intentional self-harm, initial encounter |
| T486X2A | Poisoning by antiasthmatics, intentional self-harm, initial encounter |
| T48902A | Poisoning by unspecified agents primarily acting on the respiratory system, intentional self-harm, initial encounter |
| T48992A | Poisoning by other agents primarily acting on the respiratory system, intentional self-harm, initial encounter |
| T490X2A | Poisoning by local antifungal, anti-infective and anti-inflammatory drugs, intentional self-harm, initial encounter |
| T491X2A | Poisoning by antipruritics, intentional self-harm, initial encounter |
| T492X2A | Poisoning by local astringents and local detergents, intentional self-harm, initial encounter |
| T493X2A | Poisoning by emollients, demulcents and protectants, intentional self-harm, initial encounter |
| T494X2A | Poisoning by keratolytics, keratoplastics, and other hair treatment drugs and preparations, intentional self-harm, initial encounter |
| T495X2A | Poisoning by ophthalmological drugs and preparations, intentional self-harm, initial encounter |
| T496X2A | Poisoning by otorhinolaryngological drugs and preparations, intentional self-harm, initial encounter |
| T497X2A | Poisoning by dental drugs, topically applied, intentional self-harm, initial encounter |
| T498X2A | Poisoning by other topical agents, intentional self-harm, initial encounter |
| T4992XA | Poisoning by unspecified topical agent, intentional self-harm, initial encounter |
| T500X2A | Poisoning by mineralocorticoids and their antagonists, intentional self-harm, initial encounter |
| T501X2A | Poisoning by loop [high-ceiling] diuretics, intentional self-harm, initial encounter |
| T502X2A | Poisoning by carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, intentional self-harm, initial encounter |
| T503X2A | Poisoning by electrolytic, caloric and water-balance agents, intentional self-harm, initial encounter |
| T504X2A | Poisoning by drugs affecting uric acid metabolism, intentional self-harm, initial encounter |
| T505X2A | Poisoning by appetite depressants, intentional self-harm, initial encounter |
| T506X2A | Poisoning by antidotes and chelating agents, intentional self-harm, initial encounter |
| T507X2A | Poisoning by analeptics and opioid receptor antagonists, intentional self-harm, initial encounter |
| T508X2A | Poisoning by diagnostic agents, intentional self-harm, initial encounter |
| T50902A | Poisoning by unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter |
| T50912A | Poisoning by multiple unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter |
| T50992A | Poisoning by other drugs, medicaments and biological substances, intentional self-harm, initial encounter |
| T50A12A | Poisoning by pertussis vaccine, including combinations with a pertussis component, intentional self-harm, initial encounter |
| T50A22A | Poisoning by mixed bacterial vaccines without a pertussis component, intentional self-harm, initial encounter |
| T50A92A | Poisoning by other bacterial vaccines, intentional self-harm, initial encounter |
| T50B12A | Poisoning by smallpox vaccines, intentional self-harm, initial encounter |
| T50B92A | Poisoning by other viral vaccines, intentional self-harm, initial encounter |
| T50Z12A | Poisoning by immunoglobulin, intentional self-harm, initial encounter |
| T50Z92A | Poisoning by other vaccines and biological substances, intentional self-harm, initial encounter |
| T510X2A | Toxic effect of ethanol, intentional self-harm, initial encounter |
| T511X2A | Toxic effect of methanol, intentional self-harm, initial encounter |
| T512X2A | Toxic effect of 2-Propanol, intentional self-harm, initial encounter |
| T513X2A | Toxic effect of fusel oil, intentional self-harm, initial encounter |
| T518X2A | Toxic effect of other alcohols, intentional self-harm, initial encounter |
| T5192XA | Toxic effect of unspecified alcohol, intentional self-harm, initial encounter |
| T520X2A | Toxic effect of petroleum products, intentional self-harm, initial encounter |
| T521X2A | Toxic effect of benzene, intentional self-harm, initial encounter |
| T522X2A | Toxic effect of homologues of benzene, intentional self-harm, initial encounter |
| T523X2A | Toxic effect of glycols, intentional self-harm, initial encounter |
| T524X2A | Toxic effect of ketones, intentional self-harm, initial encounter |
| T528X2A | Toxic effect of other organic solvents, intentional self-harm, initial encounter |
| T5292XA | Toxic effect of unspecified organic solvent, intentional self-harm, initial encounter |
| T530X2A | Toxic effect of carbon tetrachloride, intentional self-harm, initial encounter |
| T531X2A | Toxic effect of chloroform, intentional self-harm, initial encounter |
| T532X2A | Toxic effect of trichloroethylene, intentional self-harm, initial encounter |
| T533X2A | Toxic effect of tetrachloroethylene, intentional self-harm, initial encounter |
| T534X2A | Toxic effect of dichloromethane, intentional self-harm, initial encounter |
| T535X2A | Toxic effect of chlorofluorocarbons, intentional self-harm, initial encounter |
| T536X2A | Toxic effect of other halogen derivatives of aliphatic hydrocarbons, intentional self-harm, initial encounter |
| T537X2A | Toxic effect of other halogen derivatives of aromatic hydrocarbons, intentional self-harm, initial encounter |
| T5392XA | Toxic effect of unspecified halogen derivatives of aliphatic and aromatic hydrocarbons, intentional self-harm, initial encounter |
| T540X2A | Toxic effect of phenol and phenol homologues, intentional self-harm, initial encounter |
| T541X2A | Toxic effect of other corrosive organic compounds, intentional self-harm, initial encounter |
| T542X2A | Toxic effect of corrosive acids and acid-like substances, intentional self-harm, initial encounter |
| T543X2A | Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm, initial encounter |
| T5492XA | Toxic effect of unspecified corrosive substance, intentional self-harm, initial encounter |
| T550X2A | Toxic effect of soaps, intentional self-harm, initial encounter |
| T551X2A | Toxic effect of detergents, intentional self-harm, initial encounter |
| T560X2A | Toxic effect of lead and its compounds, intentional self-harm, initial encounter |
| T561X2A | Toxic effect of mercury and its compounds, intentional self-harm, initial encounter |
| T562X2A | Toxic effect of chromium and its compounds, intentional self-harm, initial encounter |
| T563X2A | Toxic effect of cadmium and its compounds, intentional self-harm, initial encounter |
| T564X2A | Toxic effect of copper and its compounds, intentional self-harm, initial encounter |
| T565X2A | Toxic effect of zinc and its compounds, intentional self-harm, initial encounter |
| T566X2A | Toxic effect of tin and its compounds, intentional self-harm, initial encounter |
| T567X2A | Toxic effect of beryllium and its compounds, intentional self-harm, initial encounter |
| T56812A | Toxic effect of thallium, intentional self-harm, initial encounter |
| T56822A | Toxic effect of gadolinium, intentional self-harm, initial encounter |
| T56892A | Toxic effect of other metals, intentional self-harm, initial encounter |
| T5692XA | Toxic effect of unspecified metal, intentional self-harm, initial encounter |
| T570X2A | Toxic effect of arsenic and its compounds, intentional self-harm, initial encounter |
| T571X2A | Toxic effect of phosphorus and its compounds, intentional self-harm, initial encounter |
| T572X2A | Toxic effect of manganese and its compounds, intentional self-harm, initial encounter |
| T573X2A | Toxic effect of hydrogen cyanide, intentional self-harm, initial encounter |
| T578X2A | Toxic effect of other specified inorganic substances, intentional self-harm, initial encounter |
| T5792XA | Toxic effect of unspecified inorganic substance, intentional self-harm, initial encounter |
| T5802XA | Toxic effect of carbon monoxide from motor vehicle exhaust, intentional self-harm, initial encounter |
| T5812XA | Toxic effect of carbon monoxide from utility gas, intentional self-harm, initial encounter |
| T582X2A | Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, intentional self-harm, initial encounter |
| T588X2A | Toxic effect of carbon monoxide from other source, intentional self-harm, initial encounter |
| T5892XA | Toxic effect of carbon monoxide from unspecified source, intentional self-harm, initial encounter |
| T590X2A | Toxic effect of nitrogen oxides, intentional self-harm, initial encounter |
| T591X2A | Toxic effect of sulfur dioxide, intentional self-harm, initial encounter |
| T592X2A | Toxic effect of formaldehyde, intentional self-harm, initial encounter |
| T593X2A | Toxic effect of lacrimogenic gas, intentional self-harm, initial encounter |
| T594X2A | Toxic effect of chlorine gas, intentional self-harm, initial encounter |
| T595X2A | Toxic effect of fluorine gas and hydrogen fluoride, intentional self-harm, initial encounter |
| T596X2A | Toxic effect of hydrogen sulfide, intentional self-harm, initial encounter |
| T597X2A | Toxic effect of carbon dioxide, intentional self-harm, initial encounter |
| T59812A | Toxic effect of smoke, intentional self-harm, initial encounter |
| T59892A | Toxic effect of other specified gases, fumes and vapors, intentional self-harm, initial encounter |
| T5992XA | Toxic effect of unspecified gases, fumes and vapors, intentional self-harm, initial encounter |
| T600X2A | Toxic effect of organophosphate and carbamate insecticides, intentional self-harm, initial encounter |
| T601X2A | Toxic effect of halogenated insecticides, intentional self-harm, initial encounter |
| T602X2A | Toxic effect of other insecticides, intentional self-harm, initial encounter |
| T603X2A | Toxic effect of herbicides and fungicides, intentional self-harm, initial encounter |
| T604X2A | Toxic effect of rodenticides, intentional self-harm, initial encounter |
| T608X2A | Toxic effect of other pesticides, intentional self-harm, initial encounter |
| T6092XA | Toxic effect of unspecified pesticide, intentional self-harm, initial encounter |
| T6102XA | Ciguatera fish poisoning, intentional self-harm, initial encounter |
| T6112XA | Scombroid fish poisoning, intentional self-harm, initial encounter |
| T61772A | Other fish poisoning, intentional self-harm, initial encounter |
| T61782A | Other shellfish poisoning, intentional self-harm, initial encounter |
| T618X2A | Toxic effect of other seafood, intentional self-harm, initial encounter |
| T6192XA | Toxic effect of unspecified seafood, intentional self-harm, initial encounter |
| T620X2A | Toxic effect of ingested mushrooms, intentional self-harm, initial encounter |
| T621X2A | Toxic effect of ingested berries, intentional self-harm, initial encounter |
| T622X2A | Toxic effect of other ingested (parts of) plant(s), intentional self-harm, initial encounter |
| T628X2A | Toxic effect of other specified noxious substances eaten as food, intentional self-harm, initial encounter |
| T6292XA | Toxic effect of unspecified noxious substance eaten as food, intentional self-harm, initial encounter |
| T63002A | Toxic effect of unspecified snake venom, intentional self-harm, initial encounter |
| T63012A | Toxic effect of rattlesnake venom, intentional self-harm, initial encounter |
| T63022A | Toxic effect of coral snake venom, intentional self-harm, initial encounter |
| T63032A | Toxic effect of taipan venom, intentional self-harm, initial encounter |
| T63042A | Toxic effect of cobra venom, intentional self-harm, initial encounter |
| T63062A | Toxic effect of venom of other North and South American snake, intentional self-harm, initial encounter |
| T63072A | Toxic effect of venom of other Australian snake, intentional self-harm, initial encounter |
| T63082A | Toxic effect of venom of other African and Asian snake, intentional self-harm, initial encounter |
| T63092A | Toxic effect of venom of other snake, intentional self-harm, initial encounter |
| T63112A | Toxic effect of venom of gila monster, intentional self-harm, initial encounter |
| T63122A | Toxic effect of venom of other venomous lizard, intentional self-harm, initial encounter |
| T63192A | Toxic effect of venom of other reptiles, intentional self-harm, initial encounter |
| T632X2A | Toxic effect of venom of scorpion, intentional self-harm, initial encounter |
| T63302A | Toxic effect of unspecified spider venom, intentional self-harm, initial encounter |
| T63312A | Toxic effect of venom of black widow spider, intentional self-harm, initial encounter |
| T63322A | Toxic effect of venom of tarantula, intentional self-harm, initial encounter |
| T63332A | Toxic effect of venom of brown recluse spider, intentional self-harm, initial encounter |
| T63392A | Toxic effect of venom of other spider, intentional self-harm, initial encounter |
| T63412A | Toxic effect of venom of centipedes and venomous millipedes, intentional self-harm, initial encounter |
| T63422A | Toxic effect of venom of ants, intentional self-harm, initial encounter |
| T63432A | Toxic effect of venom of caterpillars, intentional self-harm, initial encounter |
| T63442A | Toxic effect of venom of bees, intentional self-harm, initial encounter |
| T63452A | Toxic effect of venom of hornets, intentional self-harm, initial encounter |
| T63462A | Toxic effect of venom of wasps, intentional self-harm, initial encounter |
| T63482A | Toxic effect of venom of other arthropod, intentional self-harm, initial encounter |
| T63512A | Toxic effect of contact with stingray, intentional self-harm, initial encounter |
| T63592A | Toxic effect of contact with other venomous fish, intentional self-harm, initial encounter |
| T63612A | Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, initial encounter |
| T63622A | Toxic effect of contact with other jellyfish, intentional self-harm, initial encounter |
| T63632A | Toxic effect of contact with sea anemone, intentional self-harm, initial encounter |
| T63692A | Toxic effect of contact with other venomous marine animals, intentional self-harm, initial encounter |
| T63712A | Toxic effect of contact with venomous marine plant, intentional self-harm, initial encounter |
| T63792A | Toxic effect of contact with other venomous plant, intentional self-harm, initial encounter |
| T63812A | Toxic effect of contact with venomous frog, intentional self-harm, initial encounter |
| T63822A | Toxic effect of contact with venomous toad, intentional self-harm, initial encounter |
| T63832A | Toxic effect of contact with other venomous amphibian, intentional self-harm, initial encounter |
| T63892A | Toxic effect of contact with other venomous animals, intentional self-harm, initial encounter |
| T6392XA | Toxic effect of contact with unspecified venomous animal, intentional self-harm, initial encounter |
| T6402XA | Toxic effect of aflatoxin, intentional self-harm, initial encounter |
| T6482XA | Toxic effect of other mycotoxin food contaminants, intentional self-harm, initial encounter |
| T650X2A | Toxic effect of cyanides, intentional self-harm, initial encounter |
| T651X2A | Toxic effect of strychnine and its salts, intentional self-harm, initial encounter |
| T65212A | Toxic effect of chewing tobacco, intentional self-harm, initial encounter |
| T65222A | Toxic effect of tobacco cigarettes, intentional self-harm, initial encounter |
| T65292A | Toxic effect of other tobacco and nicotine, intentional self-harm, initial encounter |
| T653X2A | Toxic effect of nitroderivatives and aminoderivatives of benzene and its homologues, intentional self-harm, initial encounter |
| T654X2A | Toxic effect of carbon disulfide, intentional self-harm, initial encounter |
| T655X2A | Toxic effect of nitroglycerin and other nitric acids and esters, intentional self-harm, initial encounter |
| T656X2A | Toxic effect of paints and dyes, not elsewhere classified, intentional self-harm, initial encounter |
| T65812A | Toxic effect of latex, intentional self-harm, initial encounter |
| T65822A | Toxic effect of harmful algae and algae toxins, intentional self-harm, initial encounter |
| T65832A | Toxic effect of fiberglass, intentional self-harm, initial encounter |
| T65842A | Toxic effect of xylazine, intentional self-harm, initial encounter |
| T65892A | Toxic effect of other specified substances, intentional self-harm, initial encounter |
| T6592XA | Toxic effect of unspecified substance, intentional self-harm, initial encounter |
| T71112A | Asphyxiation due to smothering under pillow, intentional self-harm, initial encounter |
| T71122A | Asphyxiation due to plastic bag, intentional self-harm, initial encounter |
| T71132A | Asphyxiation due to being trapped in bed linens, intentional self-harm, initial encounter |
| T71152A | Asphyxiation due to smothering in furniture, intentional self-harm, initial encounter |
| T71162A | Asphyxiation due to hanging, intentional self-harm, initial encounter |
| T71192A | Asphyxiation due to mechanical threat to breathing due to other causes, intentional self-harm, initial encounter |
| T71222A | Asphyxiation due to being trapped in a car trunk, intentional self-harm, initial encounter |
| T71232A | Asphyxiation due to being trapped in a (discarded) refrigerator, intentional self-harm, initial encounter |
| X710XXA | Intentional self-harm by drowning and submersion while in bathtub, initial encounter |
| X711XXA | Intentional self-harm by drowning and submersion while in swimming pool, initial encounter |
| X712XXA | Intentional self-harm by drowning and submersion after jump into swimming pool, initial encounter |
| X713XXA | Intentional self-harm by drowning and submersion in natural water, initial encounter |
| X718XXA | Other intentional self-harm by drowning and submersion, initial encounter |
| X719XXA | Intentional self-harm by drowning and submersion, unspecified, initial encounter |
| X72XXXA | Intentional self-harm by handgun discharge, initial encounter |
| X730XXA | Intentional self-harm by shotgun discharge, initial encounter |
| X731XXA | Intentional self-harm by hunting rifle discharge, initial encounter |
| X732XXA | Intentional self-harm by machine gun discharge, initial encounter |
| X738XXA | Intentional self-harm by other larger firearm discharge, initial encounter |
| X739XXA | Intentional self-harm by unspecified larger firearm discharge, initial encounter |
| X7401XA | Intentional self-harm by airgun, initial encounter |
| X7402XA | Intentional self-harm by paintball gun, initial encounter |
| X7409XA | Intentional self-harm by other gas, air or spring-operated gun, initial encounter |
| X748XXA | Intentional self-harm by other firearm discharge, initial encounter |
| X749XXA | Intentional self-harm by unspecified firearm discharge, initial encounter |
| X75XXXA | Intentional self-harm by explosive material, initial encounter |
| X76XXXA | Intentional self-harm by smoke, fire and flames, initial encounter |
| X770XXA | Intentional self-harm by steam or hot vapors, initial encounter |
| X771XXA | Intentional self-harm by hot tap water, initial encounter |
| X772XXA | Intentional self-harm by other hot fluids, initial encounter |
| X773XXA | Intentional self-harm by hot household appliances, initial encounter |
| X778XXA | Intentional self-harm by other hot objects, initial encounter |
| X779XXA | Intentional self-harm by unspecified hot objects, initial encounter |
| X780XXA | Intentional self-harm by sharp glass, initial encounter |
| X781XXA | Intentional self-harm by knife, initial encounter |
| X782XXA | Intentional self-harm by sword or dagger, initial encounter |
| X788XXA | Intentional self-harm by other sharp object, initial encounter |
| X789XXA | Intentional self-harm by unspecified sharp object, initial encounter |
| X79XXXA | Intentional self-harm by blunt object, initial encounter |
| X80XXXA | Intentional self-harm by jumping from a high place, initial encounter |
| X810XXA | Intentional self-harm by jumping or lying in front of motor vehicle, initial encounter |
| X811XXA | Intentional self-harm by jumping or lying in front of (subway) train, initial encounter |
| X818XXA | Intentional self-harm by jumping or lying in front of other moving object, initial encounter |
| X820XXA | Intentional collision of motor vehicle with other motor vehicle, initial encounter |
| X821XXA | Intentional collision of motor vehicle with train, initial encounter |
| X822XXA | Intentional collision of motor vehicle with tree, initial encounter |
| X828XXA | Other intentional self-harm by crashing of motor vehicle, initial encounter |
| X830XXA | Intentional self-harm by crashing of aircraft, initial encounter |
| X831XXA | Intentional self-harm by electrocution, initial encounter |
| X832XXA | Intentional self-harm by exposure to extremes of cold, initial encounter |
| X838XXA | Intentional self-harm by other specified means, initial encounter |
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 HCC | Codes |
|---|---|
| 58 | 371 |
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 155?
371 ICD-10-CM codes map to HCC 155 in the CMS PY2027 initial mapping, for example F321 Major depressive disorder, single episode, moderate; F322 Major depressive disorder, single episode, severe without psychotic features; F331 Major depressive disorder, recurrent, moderate; F332 Major depressive disorder, recurrent severe without psychotic features. 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 155 add to a risk score?
The V28 relative factor for HCC 155 is 0.299 for a community, non-dual, aged beneficiary, 0.316 for full-benefit dual aged, 0.166 for non-dual disabled and 0.199 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 155 count together with related categories?
No. Within a hierarchy only the most severe category is paid. HCC 155 is dropped when HCC 151 (Schizophrenia) or HCC 152 (Psychosis, Except Schizophrenia) or HCC 153 (Personality Disorders; Anorexia/Bulimia Nervosa) or HCC 154 (Bipolar Disorders without Psychosis) is also present.
What has to be documented for HCC 155 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.
- ICD-10-CM to CMS-HCC V28 mappings, payment year 2027 initialVersion PY2027 initial ICD-10-CM mappings (dates of service 2026) · effective 2027-01-01 · file 2027 Initial ICD-10-CM Mappings.csvSHA-256 9c260b06d0dd2806…
- CMS-HCC V28 model software: labels, hierarchies and relative factorsVersion CMS-HCC V28 software V2826.115.T2 (PY2027 initial) · effective 2027-01-01 · file C2824T2N.csvSHA-256 20f38d537493b41c…
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.