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_HCC298 | 0.336 |
| Community, non-dual, disabled | CND_HCC298 | 0.364 |
| Community, full-benefit dual, aged | CFA_HCC298 | 0.323 |
| Community, full-benefit dual, disabled | CFD_HCC298 | 0.319 |
| Community, partial-benefit dual, aged | CPA_HCC298 | 0.327 |
| Community, partial-benefit dual, disabled | CPD_HCC298 | 0.301 |
| Long-term institutional | INS_HCC298 | 0.545 |
Hierarchy
HCC 298 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 298
180 codes map to this category in the PY2027 initial mapping, concentrated in the E08 (37), E10 (37), E11 (37), E13 (37), H34 (24), H36 (4) 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 |
|---|---|
| E08311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema |
| E083211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E083212 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E083213 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E083219 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E083311 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E083312 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E083313 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E083319 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E083411 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E083412 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E083413 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E083419 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E083511 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye |
| E083512 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye |
| E083513 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral |
| E083519 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E083521 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E083522 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E083523 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E083529 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E083531 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E083532 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E083533 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E083539 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E083541 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E083542 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E083543 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E083549 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E083551 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye |
| E083552 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye |
| E083553 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral |
| E083559 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye |
| E083591 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye |
| E083592 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye |
| E083593 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral |
| E083599 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E10311 | Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E103211 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E103212 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E103213 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E103219 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E103311 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E103312 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E103313 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E103319 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E103411 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E103412 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E103413 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E103419 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E103511 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E103512 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E103513 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E103519 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E103521 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E103522 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E103523 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E103529 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E103531 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E103532 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E103533 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E103539 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E103541 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E103542 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E103543 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E103549 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E103551 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E103552 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E103553 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E103559 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E103591 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E103592 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E103593 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E103599 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E11311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E113211 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E113212 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E113213 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E113219 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E113311 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E113312 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E113313 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E113319 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E113411 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E113412 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E113413 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E113419 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E113511 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E113512 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E113513 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E113519 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E113521 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E113522 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E113523 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E113529 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E113531 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E113532 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E113533 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E113539 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E113541 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E113542 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E113543 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E113549 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E113551 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E113552 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E113553 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E113559 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E113591 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E113592 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E113593 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E113599 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E13311 | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E133211 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E133212 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E133213 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E133219 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E133311 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E133312 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E133313 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E133319 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E133411 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E133412 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E133413 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E133419 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E133511 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E133512 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E133513 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E133519 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E133521 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E133522 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E133523 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E133529 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E133531 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E133532 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E133533 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E133539 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E133541 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E133542 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E133543 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E133549 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E133551 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E133552 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E133553 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E133559 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E133591 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E133592 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E133593 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E133599 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| H348110 | Central retinal vein occlusion, right eye, with macular edema |
| H348111 | Central retinal vein occlusion, right eye, with retinal neovascularization |
| H348112 | Central retinal vein occlusion, right eye, stable |
| H348120 | Central retinal vein occlusion, left eye, with macular edema |
| H348121 | Central retinal vein occlusion, left eye, with retinal neovascularization |
| H348122 | Central retinal vein occlusion, left eye, stable |
| H348130 | Central retinal vein occlusion, bilateral, with macular edema |
| H348131 | Central retinal vein occlusion, bilateral, with retinal neovascularization |
| H348132 | Central retinal vein occlusion, bilateral, stable |
| H348190 | Central retinal vein occlusion, unspecified eye, with macular edema |
| H348191 | Central retinal vein occlusion, unspecified eye, with retinal neovascularization |
| H348192 | Central retinal vein occlusion, unspecified eye, stable |
| H348310 | Tributary (branch) retinal vein occlusion, right eye, with macular edema |
| H348311 | Tributary (branch) retinal vein occlusion, right eye, with retinal neovascularization |
| H348312 | Tributary (branch) retinal vein occlusion, right eye, stable |
| H348320 | Tributary (branch) retinal vein occlusion, left eye, with macular edema |
| H348321 | Tributary (branch) retinal vein occlusion, left eye, with retinal neovascularization |
| H348322 | Tributary (branch) retinal vein occlusion, left eye, stable |
| H348330 | Tributary (branch) retinal vein occlusion, bilateral, with macular edema |
| H348331 | Tributary (branch) retinal vein occlusion, bilateral, with retinal neovascularization |
| H348332 | Tributary (branch) retinal vein occlusion, bilateral, stable |
| H348390 | Tributary (branch) retinal vein occlusion, unspecified eye, with macular edema |
| H348391 | Tributary (branch) retinal vein occlusion, unspecified eye, with retinal neovascularization |
| H348392 | Tributary (branch) retinal vein occlusion, unspecified eye, stable |
| H36821 | Proliferative sickle-cell retinopathy, right eye |
| H36822 | Proliferative sickle-cell retinopathy, left eye |
| H36823 | Proliferative sickle-cell retinopathy, bilateral |
| H36829 | Proliferative sickle-cell retinopathy, unspecified eye |
| H4310 | Vitreous hemorrhage, unspecified eye |
| H4311 | Vitreous hemorrhage, right eye |
| H4312 | Vitreous hemorrhage, left eye |
| H4313 | Vitreous hemorrhage, bilateral |
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 |
|---|---|
| 122 | 104 |
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 298?
180 ICD-10-CM codes map to HCC 298 in the CMS PY2027 initial mapping, for example E08311 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema; E083211 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye; E083212 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye; E083213 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral. 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 298 add to a risk score?
The V28 relative factor for HCC 298 is 0.336 for a community, non-dual, aged beneficiary, 0.323 for full-benefit dual aged, 0.364 for non-dual disabled and 0.545 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 298 count together with related categories?
HCC 298 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 298 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.