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HCC 328: Chronic Kidney Disease, Moderate (Stage 3B)

HCC 328, Chronic Kidney Disease, Moderate (Stage 3B), is one of the 115 payment categories in the CMS-HCC V28 model. 1 ICD-10-CM codes map to it in the payment year 2027 mapping, and a documented diagnosis in the category adds a relative factor of 0.127 to the risk score of a community, non-dual, aged beneficiary (0.179 disabled, 0.145 institutional). It is overridden when a more severe category in its hierarchy is present (HCC 326, HCC 327) and it in turn overrides HCC 329.

QuickIntell editorial content · Legacy registry date · Review not verified

Data effective
Data currency: ICD-10-CM to HCC mapping PY2027 initial (effective dates of service 2026, payment year 2027); CMS-HCC V28 model software V2826.115.T2 (effective payment year 2027). Next CMS release: PY2027 midyear final mapping (spring 2027) and PY2028 proposed model (February 2027).
Mapped ICD-10-CM codes
1
Factor, community non-dual aged
0.127
Factor, institutional
0.145
Hierarchy
Overridden by HCC 326, HCC 327
Disease group
Kidney

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.

CMS-HCC V28 relative factors for HCC 328 by model segment
SegmentModel codeRelative factor
Community, non-dual, agedCNA_HCC3280.127
Community, non-dual, disabledCND_HCC3280.179
Community, full-benefit dual, agedCFA_HCC3280.116
Community, full-benefit dual, disabledCFD_HCC3280.181
Community, partial-benefit dual, agedCPA_HCC3280.140
Community, partial-benefit dual, disabledCPD_HCC3280.178
Long-term institutionalINS_HCC3280.145

Hierarchy

Hierarchical condition categories pay only the most severe manifestation of a disease. When HCC 326 (Chronic Kidney Disease, Stage 5) or HCC 327 (Chronic Kidney Disease, Severe (Stage 4)) is also documented for the same beneficiary, HCC 328 is dropped from the score. When HCC 328 is present it drops HCC 329 (Chronic Kidney Disease, Moderate (Stage 3, Except 3B)), so documenting the less severe condition alongside it adds nothing to payment but still matters for the clinical record.

HCC 326
Chronic Kidney Disease, Stage 5 · 5 codes · factor 0.815
HCC 327
Chronic Kidney Disease, Severe (Stage 4) · 1 codes · factor 0.514
HCC 329
Chronic Kidney Disease, Moderate (Stage 3, Except 3B) · 2 codes · factor 0.127

ICD-10-CM codes that map to HCC 328

1 codes map to this category in the PY2027 initial mapping. 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 codes mapped to HCC 328 in the CMS PY2027 initial mapping
ICD-10-CMDescription
N1832Chronic kidney disease, stage 3b

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 328?

1 ICD-10-CM codes map to HCC 328 in the CMS PY2027 initial mapping, for example N1832 Chronic kidney disease, stage 3b. 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 328 add to a risk score?

The V28 relative factor for HCC 328 is 0.127 for a community, non-dual, aged beneficiary, 0.116 for full-benefit dual aged, 0.179 for non-dual disabled and 0.145 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 328 count together with related categories?

No. Within a hierarchy only the most severe category is paid. HCC 328 is dropped when HCC 326 (Chronic Kidney Disease, Stage 5) or HCC 327 (Chronic Kidney Disease, Severe (Stage 4)) is also present, and it drops HCC 329 when it is present.

What has to be documented for HCC 328 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.

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.