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_HCC21 | 0.671 |
| Community, non-dual, disabled | CND_HCC21 | 0.540 |
| Community, full-benefit dual, aged | CFA_HCC21 | 0.654 |
| Community, full-benefit dual, disabled | CFD_HCC21 | 0.739 |
| Community, partial-benefit dual, aged | CPA_HCC21 | 0.627 |
| Community, partial-benefit dual, disabled | CPD_HCC21 | 0.618 |
| Long-term institutional | INS_HCC21 | 0.493 |
Hierarchy
Hierarchical condition categories pay only the most severe manifestation of a disease. When HCC 17 (Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic) or HCC 18 (Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid) or HCC 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers) or HCC 20 (Lung and Other Severe Cancers) is also documented for the same beneficiary, HCC 21 is dropped from the score. When HCC 21 is present it drops HCC 22 (Bladder, Colorectal, and Other Cancers), HCC 23 (Prostate, Breast, and Other Cancers and Tumors), so documenting the less severe condition alongside it adds nothing to payment but still matters for the clinical record.
HCC 17
Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic · 78 codes · factor 4.209
HCC 18
Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid · 26 codes · factor 2.341
HCC 19
Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers · 68 codes · factor 1.798
HCC 20
Lung and Other Severe Cancers · 233 codes · factor 1.136
ICD-10-CM codes that map to HCC 21
463 codes map to this category in the PY2027 initial mapping, concentrated in the C82 (99), C81 (77), C85 (44), C83 (33), C4A (24), C7A (23) 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 |
|---|---|
| C01 | Malignant neoplasm of base of tongue |
| C020 | Malignant neoplasm of dorsal surface of tongue |
| C021 | Malignant neoplasm of border of tongue |
| C022 | Malignant neoplasm of ventral surface of tongue |
| C023 | Malignant neoplasm of anterior two-thirds of tongue, part unspecified |
| C024 | Malignant neoplasm of lingual tonsil |
| C028 | Malignant neoplasm of overlapping sites of tongue |
| C029 | Malignant neoplasm of tongue, unspecified |
| C030 | Malignant neoplasm of upper gum |
| C031 | Malignant neoplasm of lower gum |
| C039 | Malignant neoplasm of gum, unspecified |
| C040 | Malignant neoplasm of anterior floor of mouth |
| C041 | Malignant neoplasm of lateral floor of mouth |
| C048 | Malignant neoplasm of overlapping sites of floor of mouth |
| C049 | Malignant neoplasm of floor of mouth, unspecified |
| C050 | Malignant neoplasm of hard palate |
| C051 | Malignant neoplasm of soft palate |
| C052 | Malignant neoplasm of uvula |
| C058 | Malignant neoplasm of overlapping sites of palate |
| C059 | Malignant neoplasm of palate, unspecified |
| C060 | Malignant neoplasm of cheek mucosa |
| C061 | Malignant neoplasm of vestibule of mouth |
| C062 | Malignant neoplasm of retromolar area |
| C0680 | Malignant neoplasm of overlapping sites of unspecified parts of mouth |
| C0689 | Malignant neoplasm of overlapping sites of other parts of mouth |
| C069 | Malignant neoplasm of mouth, unspecified |
| C07 | Malignant neoplasm of parotid gland |
| C080 | Malignant neoplasm of submandibular gland |
| C081 | Malignant neoplasm of sublingual gland |
| C089 | Malignant neoplasm of major salivary gland, unspecified |
| C090 | Malignant neoplasm of tonsillar fossa |
| C091 | Malignant neoplasm of tonsillar pillar (anterior) (posterior) |
| C098 | Malignant neoplasm of overlapping sites of tonsil |
| C099 | Malignant neoplasm of tonsil, unspecified |
| C100 | Malignant neoplasm of vallecula |
| C101 | Malignant neoplasm of anterior surface of epiglottis |
| C102 | Malignant neoplasm of lateral wall of oropharynx |
| C103 | Malignant neoplasm of posterior wall of oropharynx |
| C104 | Malignant neoplasm of branchial cleft |
| C108 | Malignant neoplasm of overlapping sites of oropharynx |
| C109 | Malignant neoplasm of oropharynx, unspecified |
| C110 | Malignant neoplasm of superior wall of nasopharynx |
| C111 | Malignant neoplasm of posterior wall of nasopharynx |
| C112 | Malignant neoplasm of lateral wall of nasopharynx |
| C113 | Malignant neoplasm of anterior wall of nasopharynx |
| C118 | Malignant neoplasm of overlapping sites of nasopharynx |
| C119 | Malignant neoplasm of nasopharynx, unspecified |
| C12 | Malignant neoplasm of pyriform sinus |
| C130 | Malignant neoplasm of postcricoid region |
| C131 | Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect |
| C132 | Malignant neoplasm of posterior wall of hypopharynx |
| C138 | Malignant neoplasm of overlapping sites of hypopharynx |
| C139 | Malignant neoplasm of hypopharynx, unspecified |
| C140 | Malignant neoplasm of pharynx, unspecified |
| C142 | Malignant neoplasm of Waldeyer's ring |
| C148 | Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx |
| C300 | Malignant neoplasm of nasal cavity |
| C301 | Malignant neoplasm of middle ear |
| C310 | Malignant neoplasm of maxillary sinus |
| C311 | Malignant neoplasm of ethmoidal sinus |
| C312 | Malignant neoplasm of frontal sinus |
| C313 | Malignant neoplasm of sphenoid sinus |
| C318 | Malignant neoplasm of overlapping sites of accessory sinuses |
| C319 | Malignant neoplasm of accessory sinus, unspecified |
| C320 | Malignant neoplasm of glottis |
| C321 | Malignant neoplasm of supraglottis |
| C322 | Malignant neoplasm of subglottis |
| C323 | Malignant neoplasm of laryngeal cartilage |
| C328 | Malignant neoplasm of overlapping sites of larynx |
| C329 | Malignant neoplasm of larynx, unspecified |
| C37 | Malignant neoplasm of thymus |
| C381 | Malignant neoplasm of anterior mediastinum |
| C382 | Malignant neoplasm of posterior mediastinum |
| C383 | Malignant neoplasm of mediastinum, part unspecified |
| C388 | Malignant neoplasm of overlapping sites of heart, mediastinum and pleura |
| C390 | Malignant neoplasm of upper respiratory tract, part unspecified |
| C399 | Malignant neoplasm of lower respiratory tract, part unspecified |
| C4000 | Malignant neoplasm of scapula and long bones of unspecified upper limb |
| C4001 | Malignant neoplasm of scapula and long bones of right upper limb |
| C4002 | Malignant neoplasm of scapula and long bones of left upper limb |
| C4010 | Malignant neoplasm of short bones of unspecified upper limb |
| C4011 | Malignant neoplasm of short bones of right upper limb |
| C4012 | Malignant neoplasm of short bones of left upper limb |
| C4020 | Malignant neoplasm of long bones of unspecified lower limb |
| C4021 | Malignant neoplasm of long bones of right lower limb |
| C4022 | Malignant neoplasm of long bones of left lower limb |
| C4030 | Malignant neoplasm of short bones of unspecified lower limb |
| C4031 | Malignant neoplasm of short bones of right lower limb |
| C4032 | Malignant neoplasm of short bones of left lower limb |
| C4080 | Malignant neoplasm of overlapping sites of bone and articular cartilage of unspecified limb |
| C4081 | Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb |
| C4082 | Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb |
| C4090 | Malignant neoplasm of unspecified bones and articular cartilage of unspecified limb |
| C4091 | Malignant neoplasm of unspecified bones and articular cartilage of right limb |
| C4092 | Malignant neoplasm of unspecified bones and articular cartilage of left limb |
| C410 | Malignant neoplasm of bones of skull and face |
| C411 | Malignant neoplasm of mandible |
| C412 | Malignant neoplasm of vertebral column |
| C413 | Malignant neoplasm of ribs, sternum and clavicle |
| C414 | Malignant neoplasm of pelvic bones, sacrum and coccyx |
| C419 | Malignant neoplasm of bone and articular cartilage, unspecified |
| C460 | Kaposi's sarcoma of skin |
| C461 | Kaposi's sarcoma of soft tissue |
| C462 | Kaposi's sarcoma of palate |
| C463 | Kaposi's sarcoma of lymph nodes |
| C464 | Kaposi's sarcoma of gastrointestinal sites |
| C4650 | Kaposi's sarcoma of unspecified lung |
| C4651 | Kaposi's sarcoma of right lung |
| C4652 | Kaposi's sarcoma of left lung |
| C467 | Kaposi's sarcoma of other sites |
| C469 | Kaposi's sarcoma, unspecified |
| C470 | Malignant neoplasm of peripheral nerves of head, face and neck |
| C4710 | Malignant neoplasm of peripheral nerves of unspecified upper limb, including shoulder |
| C4711 | Malignant neoplasm of peripheral nerves of right upper limb, including shoulder |
| C4712 | Malignant neoplasm of peripheral nerves of left upper limb, including shoulder |
| C4720 | Malignant neoplasm of peripheral nerves of unspecified lower limb, including hip |
| C4721 | Malignant neoplasm of peripheral nerves of right lower limb, including hip |
| C4722 | Malignant neoplasm of peripheral nerves of left lower limb, including hip |
| C473 | Malignant neoplasm of peripheral nerves of thorax |
| C475 | Malignant neoplasm of peripheral nerves of pelvis |
| C476 | Malignant neoplasm of peripheral nerves of trunk, unspecified |
| C478 | Malignant neoplasm of overlapping sites of peripheral nerves and autonomic nervous system |
| C479 | Malignant neoplasm of peripheral nerves and autonomic nervous system, unspecified |
| C490 | Malignant neoplasm of connective and soft tissue of head, face and neck |
| C4910 | Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder |
| C4911 | Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder |
| C4912 | Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder |
| C4920 | Malignant neoplasm of connective and soft tissue of unspecified lower limb, including hip |
| C4921 | Malignant neoplasm of connective and soft tissue of right lower limb, including hip |
| C4922 | Malignant neoplasm of connective and soft tissue of left lower limb, including hip |
| C493 | Malignant neoplasm of connective and soft tissue of thorax |
| C495 | Malignant neoplasm of connective and soft tissue of pelvis |
| C496 | Malignant neoplasm of connective and soft tissue of trunk, unspecified |
| C498 | Malignant neoplasm of overlapping sites of connective and soft tissue |
| C499 | Malignant neoplasm of connective and soft tissue, unspecified |
| C4A0 | Merkel cell carcinoma of lip |
| C4A10 | Merkel cell carcinoma of unspecified eyelid, including canthus |
| C4A111 | Merkel cell carcinoma of right upper eyelid, including canthus |
| C4A112 | Merkel cell carcinoma of right lower eyelid, including canthus |
| C4A121 | Merkel cell carcinoma of left upper eyelid, including canthus |
| C4A122 | Merkel cell carcinoma of left lower eyelid, including canthus |
| C4A20 | Merkel cell carcinoma of unspecified ear and external auricular canal |
| C4A21 | Merkel cell carcinoma of right ear and external auricular canal |
| C4A22 | Merkel cell carcinoma of left ear and external auricular canal |
| C4A30 | Merkel cell carcinoma of unspecified part of face |
| C4A31 | Merkel cell carcinoma of nose |
| C4A39 | Merkel cell carcinoma of other parts of face |
| C4A4 | Merkel cell carcinoma of scalp and neck |
| C4A51 | Merkel cell carcinoma of anal skin |
| C4A52 | Merkel cell carcinoma of skin of breast |
| C4A59 | Merkel cell carcinoma of other part of trunk |
| C4A60 | Merkel cell carcinoma of unspecified upper limb, including shoulder |
| C4A61 | Merkel cell carcinoma of right upper limb, including shoulder |
| C4A62 | Merkel cell carcinoma of left upper limb, including shoulder |
| C4A70 | Merkel cell carcinoma of unspecified lower limb, including hip |
| C4A71 | Merkel cell carcinoma of right lower limb, including hip |
| C4A72 | Merkel cell carcinoma of left lower limb, including hip |
| C4A8 | Merkel cell carcinoma of overlapping sites |
| C4A9 | Merkel cell carcinoma, unspecified |
| C7A00 | Malignant carcinoid tumor of unspecified site |
| C7A010 | Malignant carcinoid tumor of the duodenum |
| C7A011 | Malignant carcinoid tumor of the jejunum |
| C7A012 | Malignant carcinoid tumor of the ileum |
| C7A019 | Malignant carcinoid tumor of the small intestine, unspecified portion |
| C7A020 | Malignant carcinoid tumor of the appendix |
| C7A021 | Malignant carcinoid tumor of the cecum |
| C7A022 | Malignant carcinoid tumor of the ascending colon |
| C7A023 | Malignant carcinoid tumor of the transverse colon |
| C7A024 | Malignant carcinoid tumor of the descending colon |
| C7A025 | Malignant carcinoid tumor of the sigmoid colon |
| C7A026 | Malignant carcinoid tumor of the rectum |
| C7A029 | Malignant carcinoid tumor of the large intestine, unspecified portion |
| C7A090 | Malignant carcinoid tumor of the bronchus and lung |
| C7A091 | Malignant carcinoid tumor of the thymus |
| C7A092 | Malignant carcinoid tumor of the stomach |
| C7A093 | Malignant carcinoid tumor of the kidney |
| C7A094 | Malignant carcinoid tumor of the foregut, unspecified |
| C7A095 | Malignant carcinoid tumor of the midgut, unspecified |
| C7A096 | Malignant carcinoid tumor of the hindgut, unspecified |
| C7A098 | Malignant carcinoid tumors of other sites |
| C7A1 | Malignant poorly differentiated neuroendocrine tumors |
| C7A8 | Other malignant neuroendocrine tumors |
| C8100 | Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site |
| C8101 | Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C8102 | Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes |
| C8103 | Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes |
| C8104 | Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C8105 | Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C8106 | Nodular lymphocyte predominant Hodgkin lymphoma, intrapelvic lymph nodes |
| C8107 | Nodular lymphocyte predominant Hodgkin lymphoma, spleen |
| C8108 | Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of multiple sites |
| C8109 | Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites |
| C810A | Nodular lymphocyte predominant Hodgkin lymphoma, in remission |
| C8110 | Nodular sclerosis Hodgkin lymphoma, unspecified site |
| C8111 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C8112 | Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes |
| C8113 | Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes |
| C8114 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C8115 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C8116 | Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes |
| C8117 | Nodular sclerosis Hodgkin lymphoma, spleen |
| C8118 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites |
| C8119 | Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites |
| C811A | Nodular sclerosis Hodgkin lymphoma, in remission |
| C8120 | Mixed cellularity Hodgkin lymphoma, unspecified site |
| C8121 | Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C8122 | Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes |
| C8123 | Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes |
| C8124 | Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C8125 | Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C8126 | Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes |
| C8127 | Mixed cellularity Hodgkin lymphoma, spleen |
| C8128 | Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites |
| C8129 | Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites |
| C812A | Mixed cellularity Hodgkin lymphoma, in remission |
| C8130 | Lymphocyte depleted Hodgkin lymphoma, unspecified site |
| C8131 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C8132 | Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes |
| C8133 | Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes |
| C8134 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C8135 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C8136 | Lymphocyte depleted Hodgkin lymphoma, intrapelvic lymph nodes |
| C8137 | Lymphocyte depleted Hodgkin lymphoma, spleen |
| C8138 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of multiple sites |
| C8139 | Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites |
| C813A | Lymphocyte depleted Hodgkin lymphoma, in remission |
| C8140 | Lymphocyte-rich Hodgkin lymphoma, unspecified site |
| C8141 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C8142 | Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes |
| C8143 | Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes |
| C8144 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C8145 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C8146 | Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes |
| C8147 | Lymphocyte-rich Hodgkin lymphoma, spleen |
| C8148 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites |
| C8149 | Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites |
| C814A | Lymphocyte-rich Hodgkin lymphoma, in remission |
| C8170 | Other Hodgkin lymphoma, unspecified site |
| C8171 | Other Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C8172 | Other Hodgkin lymphoma, intrathoracic lymph nodes |
| C8173 | Other Hodgkin lymphoma, intra-abdominal lymph nodes |
| C8174 | Other Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C8175 | Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C8176 | Other Hodgkin lymphoma, intrapelvic lymph nodes |
| C8177 | Other Hodgkin lymphoma, spleen |
| C8178 | Other Hodgkin lymphoma, lymph nodes of multiple sites |
| C8179 | Other Hodgkin lymphoma, extranodal and solid organ sites |
| C817A | Other Hodgkin lymphoma, in remission |
| C8190 | Hodgkin lymphoma, unspecified, unspecified site |
| C8191 | Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck |
| C8192 | Hodgkin lymphoma, unspecified, intrathoracic lymph nodes |
| C8193 | Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes |
| C8194 | Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C8195 | Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C8196 | Hodgkin lymphoma, unspecified, intrapelvic lymph nodes |
| C8197 | Hodgkin lymphoma, unspecified, spleen |
| C8198 | Hodgkin lymphoma, unspecified, lymph nodes of multiple sites |
| C8199 | Hodgkin lymphoma, unspecified, extranodal and solid organ sites |
| C819A | Hodgkin lymphoma, unspecified, in remission |
| C8200 | Follicular lymphoma grade I, unspecified site |
| C8201 | Follicular lymphoma grade I, lymph nodes of head, face, and neck |
| C8202 | Follicular lymphoma grade I, intrathoracic lymph nodes |
| C8203 | Follicular lymphoma grade I, intra-abdominal lymph nodes |
| C8204 | Follicular lymphoma grade I, lymph nodes of axilla and upper limb |
| C8205 | Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb |
| C8206 | Follicular lymphoma grade I, intrapelvic lymph nodes |
| C8207 | Follicular lymphoma grade I, spleen |
| C8208 | Follicular lymphoma grade I, lymph nodes of multiple sites |
| C8209 | Follicular lymphoma grade I, extranodal and solid organ sites |
| C820A | Follicular lymphoma grade I, in remission |
| C8210 | Follicular lymphoma grade II, unspecified site |
| C8211 | Follicular lymphoma grade II, lymph nodes of head, face, and neck |
| C8212 | Follicular lymphoma grade II, intrathoracic lymph nodes |
| C8213 | Follicular lymphoma grade II, intra-abdominal lymph nodes |
| C8214 | Follicular lymphoma grade II, lymph nodes of axilla and upper limb |
| C8215 | Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb |
| C8216 | Follicular lymphoma grade II, intrapelvic lymph nodes |
| C8217 | Follicular lymphoma grade II, spleen |
| C8218 | Follicular lymphoma grade II, lymph nodes of multiple sites |
| C8219 | Follicular lymphoma grade II, extranodal and solid organ sites |
| C821A | Follicular lymphoma grade II, in remission |
| C8220 | Follicular lymphoma grade III, unspecified, unspecified site |
| C8221 | Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck |
| C8222 | Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes |
| C8223 | Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes |
| C8224 | Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb |
| C8225 | Follicular lymphoma grade III, unspecified, lymph nodes of inguinal region and lower limb |
| C8226 | Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes |
| C8227 | Follicular lymphoma grade III, unspecified, spleen |
| C8228 | Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites |
| C8229 | Follicular lymphoma grade III, unspecified, extranodal and solid organ sites |
| C822A | Follicular lymphoma grade III, unspecified, in remission |
| C8230 | Follicular lymphoma grade IIIa, unspecified site |
| C8231 | Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck |
| C8232 | Follicular lymphoma grade IIIa, intrathoracic lymph nodes |
| C8233 | Follicular lymphoma grade IIIa, intra-abdominal lymph nodes |
| C8234 | Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb |
| C8235 | Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb |
| C8236 | Follicular lymphoma grade IIIa, intrapelvic lymph nodes |
| C8237 | Follicular lymphoma grade IIIa, spleen |
| C8238 | Follicular lymphoma grade IIIa, lymph nodes of multiple sites |
| C8239 | Follicular lymphoma grade IIIa, extranodal and solid organ sites |
| C823A | Follicular lymphoma grade IIIa, in remission |
| C8240 | Follicular lymphoma grade IIIb, unspecified site |
| C8241 | Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck |
| C8242 | Follicular lymphoma grade IIIb, intrathoracic lymph nodes |
| C8243 | Follicular lymphoma grade IIIb, intra-abdominal lymph nodes |
| C8244 | Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb |
| C8245 | Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb |
| C8246 | Follicular lymphoma grade IIIb, intrapelvic lymph nodes |
| C8247 | Follicular lymphoma grade IIIb, spleen |
| C8248 | Follicular lymphoma grade IIIb, lymph nodes of multiple sites |
| C8249 | Follicular lymphoma grade IIIb, extranodal and solid organ sites |
| C824A | Follicular lymphoma grade IIIb, in remission |
| C8250 | Diffuse follicle center lymphoma, unspecified site |
| C8251 | Diffuse follicle center lymphoma, lymph nodes of head, face, and neck |
| C8252 | Diffuse follicle center lymphoma, intrathoracic lymph nodes |
| C8253 | Diffuse follicle center lymphoma, intra-abdominal lymph nodes |
| C8254 | Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb |
| C8255 | Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb |
| C8256 | Diffuse follicle center lymphoma, intrapelvic lymph nodes |
| C8257 | Diffuse follicle center lymphoma, spleen |
| C8258 | Diffuse follicle center lymphoma, lymph nodes of multiple sites |
| C8259 | Diffuse follicle center lymphoma, extranodal and solid organ sites |
| C825A | Diffuse follicle center lymphoma, in remission |
| C8260 | Cutaneous follicle center lymphoma, unspecified site |
| C8261 | Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck |
| C8262 | Cutaneous follicle center lymphoma, intrathoracic lymph nodes |
| C8263 | Cutaneous follicle center lymphoma, intra-abdominal lymph nodes |
| C8264 | Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb |
| C8265 | Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb |
| C8266 | Cutaneous follicle center lymphoma, intrapelvic lymph nodes |
| C8267 | Cutaneous follicle center lymphoma, spleen |
| C8268 | Cutaneous follicle center lymphoma, lymph nodes of multiple sites |
| C8269 | Cutaneous follicle center lymphoma, extranodal and solid organ sites |
| C826A | Cutaneous follicle center lymphoma, in remission |
| C8280 | Other types of follicular lymphoma, unspecified site |
| C8281 | Other types of follicular lymphoma, lymph nodes of head, face, and neck |
| C8282 | Other types of follicular lymphoma, intrathoracic lymph nodes |
| C8283 | Other types of follicular lymphoma, intra-abdominal lymph nodes |
| C8284 | Other types of follicular lymphoma, lymph nodes of axilla and upper limb |
| C8285 | Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb |
| C8286 | Other types of follicular lymphoma, intrapelvic lymph nodes |
| C8287 | Other types of follicular lymphoma, spleen |
| C8288 | Other types of follicular lymphoma, lymph nodes of multiple sites |
| C8289 | Other types of follicular lymphoma, extranodal and solid organ sites |
| C828A | Other types of follicular lymphoma, in remission |
| C8290 | Follicular lymphoma, unspecified, unspecified site |
| C8291 | Follicular lymphoma, unspecified, lymph nodes of head, face, and neck |
| C8292 | Follicular lymphoma, unspecified, intrathoracic lymph nodes |
| C8293 | Follicular lymphoma, unspecified, intra-abdominal lymph nodes |
| C8294 | Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C8295 | Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C8296 | Follicular lymphoma, unspecified, intrapelvic lymph nodes |
| C8297 | Follicular lymphoma, unspecified, spleen |
| C8298 | Follicular lymphoma, unspecified, lymph nodes of multiple sites |
| C8299 | Follicular lymphoma, unspecified, extranodal and solid organ sites |
| C829A | Follicular lymphoma, unspecified, in remission |
| C8300 | Small cell B-cell lymphoma, unspecified site |
| C8301 | Small cell B-cell lymphoma, lymph nodes of head, face, and neck |
| C8302 | Small cell B-cell lymphoma, intrathoracic lymph nodes |
| C8303 | Small cell B-cell lymphoma, intra-abdominal lymph nodes |
| C8304 | Small cell B-cell lymphoma, lymph nodes of axilla and upper limb |
| C8305 | Small cell B-cell lymphoma, lymph nodes of inguinal region and lower limb |
| C8306 | Small cell B-cell lymphoma, intrapelvic lymph nodes |
| C8307 | Small cell B-cell lymphoma, spleen |
| C8308 | Small cell B-cell lymphoma, lymph nodes of multiple sites |
| C8309 | Small cell B-cell lymphoma, extranodal and solid organ sites |
| C830A | Small cell B-cell lymphoma, in remission |
| C8380 | Other non-follicular lymphoma, unspecified site |
| C8381 | Other non-follicular lymphoma, lymph nodes of head, face, and neck |
| C8382 | Other non-follicular lymphoma, intrathoracic lymph nodes |
| C8383 | Other non-follicular lymphoma, intra-abdominal lymph nodes |
| C8384 | Other non-follicular lymphoma, lymph nodes of axilla and upper limb |
| C8385 | Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb |
| C8386 | Other non-follicular lymphoma, intrapelvic lymph nodes |
| C8387 | Other non-follicular lymphoma, spleen |
| C8388 | Other non-follicular lymphoma, lymph nodes of multiple sites |
| C8389 | Other non-follicular lymphoma, extranodal and solid organ sites |
| C838A | Other non-follicular lymphoma, in remission |
| C8390 | Non-follicular (diffuse) lymphoma, unspecified, unspecified site |
| C8391 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck |
| C8392 | Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes |
| C8393 | Non-follicular (diffuse) lymphoma, unspecified, intra-abdominal lymph nodes |
| C8394 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C8395 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C8396 | Non-follicular (diffuse) lymphoma, unspecified, intrapelvic lymph nodes |
| C8397 | Non-follicular (diffuse) lymphoma, unspecified, spleen |
| C8398 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of multiple sites |
| C8399 | Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites |
| C839A | Non-follicular (diffuse) lymphoma, unspecified, in remission |
| C8510 | Unspecified B-cell lymphoma, unspecified site |
| C8511 | Unspecified B-cell lymphoma, lymph nodes of head, face, and neck |
| C8512 | Unspecified B-cell lymphoma, intrathoracic lymph nodes |
| C8513 | Unspecified B-cell lymphoma, intra-abdominal lymph nodes |
| C8514 | Unspecified B-cell lymphoma, lymph nodes of axilla and upper limb |
| C8515 | Unspecified B-cell lymphoma, lymph nodes of inguinal region and lower limb |
| C8516 | Unspecified B-cell lymphoma, intrapelvic lymph nodes |
| C8517 | Unspecified B-cell lymphoma, spleen |
| C8518 | Unspecified B-cell lymphoma, lymph nodes of multiple sites |
| C8519 | Unspecified B-cell lymphoma, extranodal and solid organ sites |
| C851A | Unspecified B-cell lymphoma, in remission |
| C8520 | Mediastinal (thymic) large B-cell lymphoma, unspecified site |
| C8521 | Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck |
| C8522 | Mediastinal (thymic) large B-cell lymphoma, intrathoracic lymph nodes |
| C8523 | Mediastinal (thymic) large B-cell lymphoma, intra-abdominal lymph nodes |
| C8524 | Mediastinal (thymic) large B-cell lymphoma, lymph nodes of axilla and upper limb |
| C8525 | Mediastinal (thymic) large B-cell lymphoma, lymph nodes of inguinal region and lower limb |
| C8526 | Mediastinal (thymic) large B-cell lymphoma, intrapelvic lymph nodes |
| C8527 | Mediastinal (thymic) large B-cell lymphoma, spleen |
| C8528 | Mediastinal (thymic) large B-cell lymphoma, lymph nodes of multiple sites |
| C8529 | Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites |
| C852A | Mediastinal (thymic) large B-cell lymphoma, in remission |
| C8580 | Other specified types of non-Hodgkin lymphoma, unspecified site |
| C8581 | Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck |
| C8582 | Other specified types of non-Hodgkin lymphoma, intrathoracic lymph nodes |
| C8583 | Other specified types of non-Hodgkin lymphoma, intra-abdominal lymph nodes |
| C8584 | Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C8585 | Other specified types of non-Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C8586 | Other specified types of non-Hodgkin lymphoma, intrapelvic lymph nodes |
| C8587 | Other specified types of non-Hodgkin lymphoma, spleen |
| C8588 | Other specified types of non-Hodgkin lymphoma, lymph nodes of multiple sites |
| C8589 | Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites |
| C858A | Other specified types of non-Hodgkin lymphoma, in remission |
| C8590 | Non-Hodgkin lymphoma, unspecified, unspecified site |
| C8591 | Non-Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck |
| C8592 | Non-Hodgkin lymphoma, unspecified, intrathoracic lymph nodes |
| C8593 | Non-Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes |
| C8594 | Non-Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C8595 | Non-Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C8596 | Non-Hodgkin lymphoma, unspecified, intrapelvic lymph nodes |
| C8597 | Non-Hodgkin lymphoma, unspecified, spleen |
| C8598 | Non-Hodgkin lymphoma, unspecified, lymph nodes of multiple sites |
| C8599 | Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites |
| C859A | Non-Hodgkin lymphoma, unspecified, in remission |
| C8800 | Waldenstrom macroglobulinemia not having achieved remission |
| C8801 | Waldenstrom macroglobulinemia, in remission |
| C8820 | Heavy chain disease not having achieved remission |
| C8821 | Heavy chain disease, in remission |
| C8830 | Immunoproliferative small intestinal disease not having achieved remission |
| C8831 | Immunoproliferative small intestinal disease, in remission |
| C8840 | Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma] not having achieved remission |
| C8841 | Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma], in remission |
| C8880 | Other malignant immunoproliferative diseases not having achieved remission |
| C8881 | Other malignant immunoproliferative diseases, in remission |
| C8890 | Malignant immunoproliferative disease, unspecified not having achieved remission |
| C8891 | Malignant immunoproliferative disease, unspecified, in remission |
| C960 | Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis |
| C9620 | Malignant mast cell neoplasm, unspecified |
| C9621 | Aggressive systemic mastocytosis |
| C9622 | Mast cell sarcoma |
| C9629 | Other malignant mast cell neoplasm |
| C964 | Sarcoma of dendritic cells (accessory cells) |
| C965 | Multifocal and unisystemic Langerhans-cell histiocytosis |
| C966 | Unifocal Langerhans-cell histiocytosis |
| C969 | Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified |
| C96A | Histiocytic sarcoma |
| C96Z | Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue |
| D471 | Chronic myeloproliferative disease |
| D479 | Neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified |
| D47Z1 | Post-transplant lymphoproliferative disorder (PTLD) |
| D47Z2 | Castleman disease |
| D47Z9 | Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue |
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 |
|---|---|
| 10 | 332 |
| 11 | 77 |
| 12 | 47 |
| 48 | 5 |
| 23 | 2 |
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 21?
463 ICD-10-CM codes map to HCC 21 in the CMS PY2027 initial mapping, for example C01 Malignant neoplasm of base of tongue; C020 Malignant neoplasm of dorsal surface of tongue; C021 Malignant neoplasm of border of tongue; C022 Malignant neoplasm of ventral surface of tongue. 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 21 add to a risk score?
The V28 relative factor for HCC 21 is 0.671 for a community, non-dual, aged beneficiary, 0.654 for full-benefit dual aged, 0.540 for non-dual disabled and 0.493 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 21 count together with related categories?
No. Within a hierarchy only the most severe category is paid. HCC 21 is dropped when HCC 17 (Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic) or HCC 18 (Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid) or HCC 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers) or HCC 20 (Lung and Other Severe Cancers) is also present, and it drops HCC 22, HCC 23 when it is present.
What has to be documented for HCC 21 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.