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_HCC22 | 0.363 |
| Community, non-dual, disabled | CND_HCC22 | 0.366 |
| Community, full-benefit dual, aged | CFA_HCC22 | 0.382 |
| Community, full-benefit dual, disabled | CFD_HCC22 | 0.409 |
| Community, partial-benefit dual, aged | CPA_HCC22 | 0.410 |
| Community, partial-benefit dual, disabled | CPD_HCC22 | 0.351 |
| Long-term institutional | INS_HCC22 | 0.314 |
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) or HCC 21 (Lymphoma and Other Cancers) is also documented for the same beneficiary, HCC 22 is dropped from the score. When HCC 22 is present it drops 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.
ICD-10-CM codes that map to HCC 22
126 codes map to this category in the PY2027 initial mapping, concentrated in the D3A (22), C57 (14), C91 (12), C18 (10), C67 (10), C74 (9) 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 |
|---|---|
| C180 | Malignant neoplasm of cecum |
| C181 | Malignant neoplasm of appendix |
| C182 | Malignant neoplasm of ascending colon |
| C183 | Malignant neoplasm of hepatic flexure |
| C184 | Malignant neoplasm of transverse colon |
| C185 | Malignant neoplasm of splenic flexure |
| C186 | Malignant neoplasm of descending colon |
| C187 | Malignant neoplasm of sigmoid colon |
| C188 | Malignant neoplasm of overlapping sites of colon |
| C189 | Malignant neoplasm of colon, unspecified |
| C19 | Malignant neoplasm of rectosigmoid junction |
| C20 | Malignant neoplasm of rectum |
| C210 | Malignant neoplasm of anus, unspecified |
| C211 | Malignant neoplasm of anal canal |
| C212 | Malignant neoplasm of cloacogenic zone |
| C218 | Malignant neoplasm of overlapping sites of rectum, anus and anal canal |
| C260 | Malignant neoplasm of intestinal tract, part unspecified |
| C261 | Malignant neoplasm of spleen |
| C269 | Malignant neoplasm of ill-defined sites within the digestive system |
| C510 | Malignant neoplasm of labium majus |
| C511 | Malignant neoplasm of labium minus |
| C512 | Malignant neoplasm of clitoris |
| C518 | Malignant neoplasm of overlapping sites of vulva |
| C519 | Malignant neoplasm of vulva, unspecified |
| C52 | Malignant neoplasm of vagina |
| C530 | Malignant neoplasm of endocervix |
| C531 | Malignant neoplasm of exocervix |
| C538 | Malignant neoplasm of overlapping sites of cervix uteri |
| C539 | Malignant neoplasm of cervix uteri, unspecified |
| C561 | Malignant neoplasm of right ovary |
| C562 | Malignant neoplasm of left ovary |
| C563 | Malignant neoplasm of bilateral ovaries |
| C569 | Malignant neoplasm of unspecified ovary |
| C5700 | Malignant neoplasm of unspecified fallopian tube |
| C5701 | Malignant neoplasm of right fallopian tube |
| C5702 | Malignant neoplasm of left fallopian tube |
| C5710 | Malignant neoplasm of unspecified broad ligament |
| C5711 | Malignant neoplasm of right broad ligament |
| C5712 | Malignant neoplasm of left broad ligament |
| C5720 | Malignant neoplasm of unspecified round ligament |
| C5721 | Malignant neoplasm of right round ligament |
| C5722 | Malignant neoplasm of left round ligament |
| C573 | Malignant neoplasm of parametrium |
| C574 | Malignant neoplasm of uterine adnexa, unspecified |
| C577 | Malignant neoplasm of other specified female genital organs |
| C578 | Malignant neoplasm of overlapping sites of female genital organs |
| C579 | Malignant neoplasm of female genital organ, unspecified |
| C58 | Malignant neoplasm of placenta |
| C641 | Malignant neoplasm of right kidney, except renal pelvis |
| C642 | Malignant neoplasm of left kidney, except renal pelvis |
| C649 | Malignant neoplasm of unspecified kidney, except renal pelvis |
| C651 | Malignant neoplasm of right renal pelvis |
| C652 | Malignant neoplasm of left renal pelvis |
| C659 | Malignant neoplasm of unspecified renal pelvis |
| C661 | Malignant neoplasm of right ureter |
| C662 | Malignant neoplasm of left ureter |
| C669 | Malignant neoplasm of unspecified ureter |
| C670 | Malignant neoplasm of trigone of bladder |
| C671 | Malignant neoplasm of dome of bladder |
| C672 | Malignant neoplasm of lateral wall of bladder |
| C673 | Malignant neoplasm of anterior wall of bladder |
| C674 | Malignant neoplasm of posterior wall of bladder |
| C675 | Malignant neoplasm of bladder neck |
| C676 | Malignant neoplasm of ureteric orifice |
| C677 | Malignant neoplasm of urachus |
| C678 | Malignant neoplasm of overlapping sites of bladder |
| C679 | Malignant neoplasm of bladder, unspecified |
| C680 | Malignant neoplasm of urethra |
| C681 | Malignant neoplasm of paraurethral glands |
| C688 | Malignant neoplasm of overlapping sites of urinary organs |
| C689 | Malignant neoplasm of urinary organ, unspecified |
| C7400 | Malignant neoplasm of cortex of unspecified adrenal gland |
| C7401 | Malignant neoplasm of cortex of right adrenal gland |
| C7402 | Malignant neoplasm of cortex of left adrenal gland |
| C7410 | Malignant neoplasm of medulla of unspecified adrenal gland |
| C7411 | Malignant neoplasm of medulla of right adrenal gland |
| C7412 | Malignant neoplasm of medulla of left adrenal gland |
| C7490 | Malignant neoplasm of unspecified part of unspecified adrenal gland |
| C7491 | Malignant neoplasm of unspecified part of right adrenal gland |
| C7492 | Malignant neoplasm of unspecified part of left adrenal gland |
| C9110 | Chronic lymphocytic leukemia of B-cell type not having achieved remission |
| C9111 | Chronic lymphocytic leukemia of B-cell type in remission |
| C9112 | Chronic lymphocytic leukemia of B-cell type in relapse |
| C9140 | Hairy cell leukemia not having achieved remission |
| C9141 | Hairy cell leukemia, in remission |
| C9142 | Hairy cell leukemia, in relapse |
| C9190 | Lymphoid leukemia, unspecified not having achieved remission |
| C9191 | Lymphoid leukemia, unspecified, in remission |
| C9192 | Lymphoid leukemia, unspecified, in relapse |
| C91Z0 | Other lymphoid leukemia not having achieved remission |
| C91Z1 | Other lymphoid leukemia, in remission |
| C91Z2 | Other lymphoid leukemia, in relapse |
| C9210 | Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission |
| C9211 | Chronic myeloid leukemia, BCR/ABL-positive, in remission |
| C9212 | Chronic myeloid leukemia, BCR/ABL-positive, in relapse |
| C9240 | Acute promyelocytic leukemia, not having achieved remission |
| C9241 | Acute promyelocytic leukemia, in remission |
| C9242 | Acute promyelocytic leukemia, in relapse |
| C9510 | Chronic leukemia of unspecified cell type not having achieved remission |
| C9511 | Chronic leukemia of unspecified cell type, in remission |
| C9512 | Chronic leukemia of unspecified cell type, in relapse |
| C9590 | Leukemia, unspecified not having achieved remission |
| C9591 | Leukemia, unspecified, in remission |
| C9592 | Leukemia, unspecified, in relapse |
| D3A00 | Benign carcinoid tumor of unspecified site |
| D3A010 | Benign carcinoid tumor of the duodenum |
| D3A011 | Benign carcinoid tumor of the jejunum |
| D3A012 | Benign carcinoid tumor of the ileum |
| D3A019 | Benign carcinoid tumor of the small intestine, unspecified portion |
| D3A020 | Benign carcinoid tumor of the appendix |
| D3A021 | Benign carcinoid tumor of the cecum |
| D3A022 | Benign carcinoid tumor of the ascending colon |
| D3A023 | Benign carcinoid tumor of the transverse colon |
| D3A024 | Benign carcinoid tumor of the descending colon |
| D3A025 | Benign carcinoid tumor of the sigmoid colon |
| D3A026 | Benign carcinoid tumor of the rectum |
| D3A029 | Benign carcinoid tumor of the large intestine, unspecified portion |
| D3A090 | Benign carcinoid tumor of the bronchus and lung |
| D3A091 | Benign carcinoid tumor of the thymus |
| D3A092 | Benign carcinoid tumor of the stomach |
| D3A093 | Benign carcinoid tumor of the kidney |
| D3A094 | Benign carcinoid tumor of the foregut, unspecified |
| D3A095 | Benign carcinoid tumor of the midgut, unspecified |
| D3A096 | Benign carcinoid tumor of the hindgut, unspecified |
| D3A098 | Benign carcinoid tumors of other sites |
| D3A8 | Other benign neuroendocrine tumors |
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 |
|---|---|
| 11 | 55 |
| 10 | 43 |
| 9 | 3 |
| 8 | 3 |
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 22?
126 ICD-10-CM codes map to HCC 22 in the CMS PY2027 initial mapping, for example C180 Malignant neoplasm of cecum; C181 Malignant neoplasm of appendix; C182 Malignant neoplasm of ascending colon; C183 Malignant neoplasm of hepatic flexure. 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 22 add to a risk score?
The V28 relative factor for HCC 22 is 0.363 for a community, non-dual, aged beneficiary, 0.382 for full-benefit dual aged, 0.366 for non-dual disabled and 0.314 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 22 count together with related categories?
No. Within a hierarchy only the most severe category is paid. HCC 22 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) or HCC 21 (Lymphoma and Other Cancers) is also present, and it drops HCC 23 when it is present.
What has to be documented for HCC 22 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.