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_HCC267 | 0.294 |
| Community, non-dual, disabled | CND_HCC267 | 0.431 |
| Community, full-benefit dual, aged | CFA_HCC267 | 0.445 |
| Community, full-benefit dual, disabled | CFD_HCC267 | 0.568 |
| Community, partial-benefit dual, aged | CPA_HCC267 | 0.338 |
| Community, partial-benefit dual, disabled | CPD_HCC267 | 0.498 |
| Long-term institutional | INS_HCC267 | 0.245 |
Hierarchy
HCC 267 is not part of a hierarchy: it is paid whenever a mapped diagnosis is documented, independently of the beneficiary's other categories.
ICD-10-CM codes that map to HCC 267
167 codes map to this category in the PY2027 initial mapping, concentrated in the I82 (120), I80 (32), I26 (12), T79 (2), I27 (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 |
|---|---|
| I2601 | Septic pulmonary embolism with acute cor pulmonale |
| I2602 | Saddle embolus of pulmonary artery with acute cor pulmonale |
| I2603 | Cement embolism of pulmonary artery with acute cor pulmonale |
| I2604 | Fat embolism of pulmonary artery with acute cor pulmonale |
| I2609 | Other pulmonary embolism with acute cor pulmonale |
| I2690 | Septic pulmonary embolism without acute cor pulmonale |
| I2692 | Saddle embolus of pulmonary artery without acute cor pulmonale |
| I2693 | Single subsegmental thrombotic pulmonary embolism without acute cor pulmonale |
| I2694 | Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale |
| I2695 | Cement embolism of pulmonary artery without acute cor pulmonale |
| I2696 | Fat embolism of pulmonary artery without acute cor pulmonale |
| I2699 | Other pulmonary embolism without acute cor pulmonale |
| I2782 | Chronic pulmonary embolism |
| I8010 | Phlebitis and thrombophlebitis of unspecified femoral vein |
| I8011 | Phlebitis and thrombophlebitis of right femoral vein |
| I8012 | Phlebitis and thrombophlebitis of left femoral vein |
| I8013 | Phlebitis and thrombophlebitis of femoral vein, bilateral |
| I80201 | Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity |
| I80202 | Phlebitis and thrombophlebitis of unspecified deep vessels of left lower extremity |
| I80203 | Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities, bilateral |
| I80209 | Phlebitis and thrombophlebitis of unspecified deep vessels of unspecified lower extremity |
| I80211 | Phlebitis and thrombophlebitis of right iliac vein |
| I80212 | Phlebitis and thrombophlebitis of left iliac vein |
| I80213 | Phlebitis and thrombophlebitis of iliac vein, bilateral |
| I80219 | Phlebitis and thrombophlebitis of unspecified iliac vein |
| I80221 | Phlebitis and thrombophlebitis of right popliteal vein |
| I80222 | Phlebitis and thrombophlebitis of left popliteal vein |
| I80223 | Phlebitis and thrombophlebitis of popliteal vein, bilateral |
| I80229 | Phlebitis and thrombophlebitis of unspecified popliteal vein |
| I80231 | Phlebitis and thrombophlebitis of right tibial vein |
| I80232 | Phlebitis and thrombophlebitis of left tibial vein |
| I80233 | Phlebitis and thrombophlebitis of tibial vein, bilateral |
| I80239 | Phlebitis and thrombophlebitis of unspecified tibial vein |
| I80241 | Phlebitis and thrombophlebitis of right peroneal vein |
| I80242 | Phlebitis and thrombophlebitis of left peroneal vein |
| I80243 | Phlebitis and thrombophlebitis of peroneal vein, bilateral |
| I80249 | Phlebitis and thrombophlebitis of unspecified peroneal vein |
| I80251 | Phlebitis and thrombophlebitis of right calf muscular vein |
| I80252 | Phlebitis and thrombophlebitis of left calf muscular vein |
| I80253 | Phlebitis and thrombophlebitis of calf muscular vein, bilateral |
| I80259 | Phlebitis and thrombophlebitis of unspecified calf muscular vein |
| I80291 | Phlebitis and thrombophlebitis of other deep vessels of right lower extremity |
| I80292 | Phlebitis and thrombophlebitis of other deep vessels of left lower extremity |
| I80293 | Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral |
| I80299 | Phlebitis and thrombophlebitis of other deep vessels of unspecified lower extremity |
| I820 | Budd-Chiari syndrome |
| I82210 | Acute embolism and thrombosis of superior vena cava |
| I82211 | Chronic embolism and thrombosis of superior vena cava |
| I82220 | Acute embolism and thrombosis of inferior vena cava |
| I82221 | Chronic embolism and thrombosis of inferior vena cava |
| I82290 | Acute embolism and thrombosis of other thoracic veins |
| I82291 | Chronic embolism and thrombosis of other thoracic veins |
| I823 | Embolism and thrombosis of renal vein |
| I82401 | Acute embolism and thrombosis of unspecified deep veins of right lower extremity |
| I82402 | Acute embolism and thrombosis of unspecified deep veins of left lower extremity |
| I82403 | Acute embolism and thrombosis of unspecified deep veins of lower extremity, bilateral |
| I82409 | Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity |
| I82411 | Acute embolism and thrombosis of right femoral vein |
| I82412 | Acute embolism and thrombosis of left femoral vein |
| I82413 | Acute embolism and thrombosis of femoral vein, bilateral |
| I82419 | Acute embolism and thrombosis of unspecified femoral vein |
| I82421 | Acute embolism and thrombosis of right iliac vein |
| I82422 | Acute embolism and thrombosis of left iliac vein |
| I82423 | Acute embolism and thrombosis of iliac vein, bilateral |
| I82429 | Acute embolism and thrombosis of unspecified iliac vein |
| I82431 | Acute embolism and thrombosis of right popliteal vein |
| I82432 | Acute embolism and thrombosis of left popliteal vein |
| I82433 | Acute embolism and thrombosis of popliteal vein, bilateral |
| I82439 | Acute embolism and thrombosis of unspecified popliteal vein |
| I82441 | Acute embolism and thrombosis of right tibial vein |
| I82442 | Acute embolism and thrombosis of left tibial vein |
| I82443 | Acute embolism and thrombosis of tibial vein, bilateral |
| I82449 | Acute embolism and thrombosis of unspecified tibial vein |
| I82451 | Acute embolism and thrombosis of right peroneal vein |
| I82452 | Acute embolism and thrombosis of left peroneal vein |
| I82453 | Acute embolism and thrombosis of peroneal vein, bilateral |
| I82459 | Acute embolism and thrombosis of unspecified peroneal vein |
| I82461 | Acute embolism and thrombosis of right calf muscular vein |
| I82462 | Acute embolism and thrombosis of left calf muscular vein |
| I82463 | Acute embolism and thrombosis of calf muscular vein, bilateral |
| I82469 | Acute embolism and thrombosis of unspecified calf muscular vein |
| I82491 | Acute embolism and thrombosis of other specified deep vein of right lower extremity |
| I82492 | Acute embolism and thrombosis of other specified deep vein of left lower extremity |
| I82493 | Acute embolism and thrombosis of other specified deep vein of lower extremity, bilateral |
| I82499 | Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity |
| I824Y1 | Acute embolism and thrombosis of unspecified deep veins of right proximal lower extremity |
| I824Y2 | Acute embolism and thrombosis of unspecified deep veins of left proximal lower extremity |
| I824Y3 | Acute embolism and thrombosis of unspecified deep veins of proximal lower extremity, bilateral |
| I824Y9 | Acute embolism and thrombosis of unspecified deep veins of unspecified proximal lower extremity |
| I824Z1 | Acute embolism and thrombosis of unspecified deep veins of right distal lower extremity |
| I824Z2 | Acute embolism and thrombosis of unspecified deep veins of left distal lower extremity |
| I824Z3 | Acute embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral |
| I824Z9 | Acute embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity |
| I82501 | Chronic embolism and thrombosis of unspecified deep veins of right lower extremity |
| I82502 | Chronic embolism and thrombosis of unspecified deep veins of left lower extremity |
| I82503 | Chronic embolism and thrombosis of unspecified deep veins of lower extremity, bilateral |
| I82509 | Chronic embolism and thrombosis of unspecified deep veins of unspecified lower extremity |
| I82511 | Chronic embolism and thrombosis of right femoral vein |
| I82512 | Chronic embolism and thrombosis of left femoral vein |
| I82513 | Chronic embolism and thrombosis of femoral vein, bilateral |
| I82519 | Chronic embolism and thrombosis of unspecified femoral vein |
| I82521 | Chronic embolism and thrombosis of right iliac vein |
| I82522 | Chronic embolism and thrombosis of left iliac vein |
| I82523 | Chronic embolism and thrombosis of iliac vein, bilateral |
| I82529 | Chronic embolism and thrombosis of unspecified iliac vein |
| I82531 | Chronic embolism and thrombosis of right popliteal vein |
| I82532 | Chronic embolism and thrombosis of left popliteal vein |
| I82533 | Chronic embolism and thrombosis of popliteal vein, bilateral |
| I82539 | Chronic embolism and thrombosis of unspecified popliteal vein |
| I82541 | Chronic embolism and thrombosis of right tibial vein |
| I82542 | Chronic embolism and thrombosis of left tibial vein |
| I82543 | Chronic embolism and thrombosis of tibial vein, bilateral |
| I82549 | Chronic embolism and thrombosis of unspecified tibial vein |
| I82551 | Chronic embolism and thrombosis of right peroneal vein |
| I82552 | Chronic embolism and thrombosis of left peroneal vein |
| I82553 | Chronic embolism and thrombosis of peroneal vein, bilateral |
| I82559 | Chronic embolism and thrombosis of unspecified peroneal vein |
| I82561 | Chronic embolism and thrombosis of right calf muscular vein |
| I82562 | Chronic embolism and thrombosis of left calf muscular vein |
| I82563 | Chronic embolism and thrombosis of calf muscular vein, bilateral |
| I82569 | Chronic embolism and thrombosis of unspecified calf muscular vein |
| I82591 | Chronic embolism and thrombosis of other specified deep vein of right lower extremity |
| I82592 | Chronic embolism and thrombosis of other specified deep vein of left lower extremity |
| I82593 | Chronic embolism and thrombosis of other specified deep vein of lower extremity, bilateral |
| I82599 | Chronic embolism and thrombosis of other specified deep vein of unspecified lower extremity |
| I825Y1 | Chronic embolism and thrombosis of unspecified deep veins of right proximal lower extremity |
| I825Y2 | Chronic embolism and thrombosis of unspecified deep veins of left proximal lower extremity |
| I825Y3 | Chronic embolism and thrombosis of unspecified deep veins of proximal lower extremity, bilateral |
| I825Y9 | Chronic embolism and thrombosis of unspecified deep veins of unspecified proximal lower extremity |
| I825Z1 | Chronic embolism and thrombosis of unspecified deep veins of right distal lower extremity |
| I825Z2 | Chronic embolism and thrombosis of unspecified deep veins of left distal lower extremity |
| I825Z3 | Chronic embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral |
| I825Z9 | Chronic embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity |
| I82621 | Acute embolism and thrombosis of deep veins of right upper extremity |
| I82622 | Acute embolism and thrombosis of deep veins of left upper extremity |
| I82623 | Acute embolism and thrombosis of deep veins of upper extremity, bilateral |
| I82629 | Acute embolism and thrombosis of deep veins of unspecified upper extremity |
| I82721 | Chronic embolism and thrombosis of deep veins of right upper extremity |
| I82722 | Chronic embolism and thrombosis of deep veins of left upper extremity |
| I82723 | Chronic embolism and thrombosis of deep veins of upper extremity, bilateral |
| I82729 | Chronic embolism and thrombosis of deep veins of unspecified upper extremity |
| I82A11 | Acute embolism and thrombosis of right axillary vein |
| I82A12 | Acute embolism and thrombosis of left axillary vein |
| I82A13 | Acute embolism and thrombosis of axillary vein, bilateral |
| I82A19 | Acute embolism and thrombosis of unspecified axillary vein |
| I82A21 | Chronic embolism and thrombosis of right axillary vein |
| I82A22 | Chronic embolism and thrombosis of left axillary vein |
| I82A23 | Chronic embolism and thrombosis of axillary vein, bilateral |
| I82A29 | Chronic embolism and thrombosis of unspecified axillary vein |
| I82B11 | Acute embolism and thrombosis of right subclavian vein |
| I82B12 | Acute embolism and thrombosis of left subclavian vein |
| I82B13 | Acute embolism and thrombosis of subclavian vein, bilateral |
| I82B19 | Acute embolism and thrombosis of unspecified subclavian vein |
| I82B21 | Chronic embolism and thrombosis of right subclavian vein |
| I82B22 | Chronic embolism and thrombosis of left subclavian vein |
| I82B23 | Chronic embolism and thrombosis of subclavian vein, bilateral |
| I82B29 | Chronic embolism and thrombosis of unspecified subclavian vein |
| I82C11 | Acute embolism and thrombosis of right internal jugular vein |
| I82C12 | Acute embolism and thrombosis of left internal jugular vein |
| I82C13 | Acute embolism and thrombosis of internal jugular vein, bilateral |
| I82C19 | Acute embolism and thrombosis of unspecified internal jugular vein |
| I82C21 | Chronic embolism and thrombosis of right internal jugular vein |
| I82C22 | Chronic embolism and thrombosis of left internal jugular vein |
| I82C23 | Chronic embolism and thrombosis of internal jugular vein, bilateral |
| I82C29 | Chronic embolism and thrombosis of unspecified internal jugular vein |
| T790XXA | Air embolism (traumatic), initial encounter |
| T791XXA | Fat embolism (traumatic), 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 |
|---|---|
| 108 | 152 |
| 107 | 8 |
| 85 | 5 |
| 173 | 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 267?
167 ICD-10-CM codes map to HCC 267 in the CMS PY2027 initial mapping, for example I2601 Septic pulmonary embolism with acute cor pulmonale; I2602 Saddle embolus of pulmonary artery with acute cor pulmonale; I2603 Cement embolism of pulmonary artery with acute cor pulmonale; I2604 Fat embolism of pulmonary artery with acute cor pulmonale. 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 267 add to a risk score?
The V28 relative factor for HCC 267 is 0.294 for a community, non-dual, aged beneficiary, 0.445 for full-benefit dual aged, 0.431 for non-dual disabled and 0.245 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 267 count together with related categories?
HCC 267 is not part of a hierarchy, so it is paid whenever it is documented regardless of which other categories the beneficiary has.
What has to be documented for HCC 267 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.