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_HCC263 | 1.118 |
| Community, non-dual, disabled | CND_HCC263 | 1.066 |
| Community, full-benefit dual, aged | CFA_HCC263 | 1.432 |
| Community, full-benefit dual, disabled | CFD_HCC263 | 1.276 |
| Community, partial-benefit dual, aged | CPA_HCC263 | 1.007 |
| Community, partial-benefit dual, disabled | CPD_HCC263 | 1.056 |
| Long-term institutional | INS_HCC263 | 0.696 |
Hierarchy
Hierarchical condition categories pay only the most severe manifestation of a disease. HCC 263 is the most severe category in its hierarchy. When HCC 263 is present it drops HCC 264 (Vascular Disease with Complications), HCC 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle), HCC 409 (Amputation Status, Lower Limb/Amputation Complications), 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 263
127 codes map to this category in the PY2027 initial mapping, concentrated in the I70 (120), A48 (1), E08 (1), E10 (1), E11 (1), E13 (1) 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 |
|---|---|
| A480 | Gas gangrene |
| E0852 | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene |
| E1052 | Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E1152 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E1352 | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| I70231 | Atherosclerosis of native arteries of right leg with ulceration of thigh |
| I70232 | Atherosclerosis of native arteries of right leg with ulceration of calf |
| I70233 | Atherosclerosis of native arteries of right leg with ulceration of ankle |
| I70234 | Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot |
| I70235 | Atherosclerosis of native arteries of right leg with ulceration of other part of foot |
| I70238 | Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg |
| I70239 | Atherosclerosis of native arteries of right leg with ulceration of unspecified site |
| I70241 | Atherosclerosis of native arteries of left leg with ulceration of thigh |
| I70242 | Atherosclerosis of native arteries of left leg with ulceration of calf |
| I70243 | Atherosclerosis of native arteries of left leg with ulceration of ankle |
| I70244 | Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot |
| I70245 | Atherosclerosis of native arteries of left leg with ulceration of other part of foot |
| I70248 | Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg |
| I70249 | Atherosclerosis of native arteries of left leg with ulceration of unspecified site |
| I7025 | Atherosclerosis of native arteries of other extremities with ulceration |
| I70261 | Atherosclerosis of native arteries of extremities with gangrene, right leg |
| I70262 | Atherosclerosis of native arteries of extremities with gangrene, left leg |
| I70263 | Atherosclerosis of native arteries of extremities with gangrene, bilateral legs |
| I70268 | Atherosclerosis of native arteries of extremities with gangrene, other extremity |
| I70269 | Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity |
| I70331 | Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of thigh |
| I70332 | Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of calf |
| I70333 | Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of ankle |
| I70334 | Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot |
| I70335 | Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of foot |
| I70338 | Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of lower leg |
| I70339 | Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of unspecified site |
| I70341 | Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of thigh |
| I70342 | Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of calf |
| I70343 | Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of ankle |
| I70344 | Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of heel and midfoot |
| I70345 | Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of foot |
| I70348 | Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of lower leg |
| I70349 | Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of unspecified site |
| I7035 | Atherosclerosis of unspecified type of bypass graft(s) of other extremity with ulceration |
| I70361 | Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, right leg |
| I70362 | Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, left leg |
| I70363 | Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, bilateral legs |
| I70368 | Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, other extremity |
| I70369 | Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, unspecified extremity |
| I70431 | Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh |
| I70432 | Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf |
| I70433 | Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle |
| I70434 | Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot |
| I70435 | Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot |
| I70438 | Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of lower leg |
| I70439 | Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of unspecified site |
| I70441 | Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh |
| I70442 | Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of calf |
| I70443 | Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle |
| I70444 | Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot |
| I70445 | Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot |
| I70448 | Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of lower leg |
| I70449 | Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of unspecified site |
| I7045 | Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration |
| I70461 | Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg |
| I70462 | Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg |
| I70463 | Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs |
| I70468 | Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, other extremity |
| I70469 | Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, unspecified extremity |
| I70531 | Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh |
| I70532 | Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf |
| I70533 | Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle |
| I70534 | Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot |
| I70535 | Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot |
| I70538 | Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of lower leg |
| I70539 | Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of unspecified site |
| I70541 | Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh |
| I70542 | Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf |
| I70543 | Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle |
| I70544 | Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot |
| I70545 | Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot |
| I70548 | Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of lower leg |
| I70549 | Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of unspecified site |
| I7055 | Atherosclerosis of nonautologous biological bypass graft(s) of other extremity with ulceration |
| I70561 | Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg |
| I70562 | Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg |
| I70563 | Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs |
| I70568 | Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, other extremity |
| I70569 | Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, unspecified extremity |
| I70631 | Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh |
| I70632 | Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf |
| I70633 | Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle |
| I70634 | Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot |
| I70635 | Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot |
| I70638 | Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of lower leg |
| I70639 | Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of unspecified site |
| I70641 | Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh |
| I70642 | Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf |
| I70643 | Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle |
| I70644 | Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot |
| I70645 | Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot |
| I70648 | Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of lower leg |
| I70649 | Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of unspecified site |
| I7065 | Atherosclerosis of nonbiological bypass graft(s) of other extremity with ulceration |
| I70661 | Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, right leg |
| I70662 | Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg |
| I70663 | Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs |
| I70668 | Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, other extremity |
| I70669 | Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, unspecified extremity |
| I70731 | Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh |
| I70732 | Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf |
| I70733 | Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle |
| I70734 | Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot |
| I70735 | Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot |
| I70738 | Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of lower leg |
| I70739 | Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of unspecified site |
| I70741 | Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh |
| I70742 | Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf |
| I70743 | Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle |
| I70744 | Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot |
| I70745 | Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot |
| I70748 | Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of lower leg |
| I70749 | Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of unspecified site |
| I7075 | Atherosclerosis of other type of bypass graft(s) of other extremity with ulceration |
| I70761 | Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, right leg |
| I70762 | Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, left leg |
| I70763 | Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, bilateral legs |
| I70768 | Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, other extremity |
| I70769 | Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, unspecified extremity |
| I7301 | Raynaud's syndrome with gangrene |
| I96 | Gangrene, not elsewhere classified |
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 |
|---|---|
| 106 | 127 |
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 263?
127 ICD-10-CM codes map to HCC 263 in the CMS PY2027 initial mapping, for example A480 Gas gangrene; E0852 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene; E1052 Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene; E1152 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene. 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 263 add to a risk score?
The V28 relative factor for HCC 263 is 1.118 for a community, non-dual, aged beneficiary, 1.432 for full-benefit dual aged, 1.066 for non-dual disabled and 0.696 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 263 count together with related categories?
No. Within a hierarchy only the most severe category is paid. HCC 263 is the most severe category in its hierarchy, and it drops HCC 264, HCC 383, HCC 409 when it is present.
What has to be documented for HCC 263 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.