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_HCC380 | 1.078 |
| Community, non-dual, disabled | CND_HCC380 | 1.091 |
| Community, full-benefit dual, aged | CFA_HCC380 | 1.422 |
| Community, full-benefit dual, disabled | CFD_HCC380 | 1.285 |
| Community, partial-benefit dual, aged | CPA_HCC380 | 1.268 |
| Community, partial-benefit dual, disabled | CPD_HCC380 | 1.378 |
| Long-term institutional | INS_HCC380 | 0.839 |
Hierarchy
Hierarchical condition categories pay only the most severe manifestation of a disease. When HCC 379 (Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone) is also documented for the same beneficiary, HCC 380 is dropped from the score. When HCC 380 is present it drops HCC 381 (Pressure Ulcer of Skin with Full Thickness Skin Loss), HCC 382 (Pressure Ulcer of Skin with Partial Thickness Skin Loss), HCC 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle), 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 380
152 codes map to this category in the PY2027 initial mapping, concentrated in the L97 (84), L98 (68) 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 |
|---|---|
| L97103 | Non-pressure chronic ulcer of unspecified thigh with necrosis of muscle |
| L97104 | Non-pressure chronic ulcer of unspecified thigh with necrosis of bone |
| L97105 | Non-pressure chronic ulcer of unspecified thigh with muscle involvement without evidence of necrosis |
| L97106 | Non-pressure chronic ulcer of unspecified thigh with bone involvement without evidence of necrosis |
| L97113 | Non-pressure chronic ulcer of right thigh with necrosis of muscle |
| L97114 | Non-pressure chronic ulcer of right thigh with necrosis of bone |
| L97115 | Non-pressure chronic ulcer of right thigh with muscle involvement without evidence of necrosis |
| L97116 | Non-pressure chronic ulcer of right thigh with bone involvement without evidence of necrosis |
| L97123 | Non-pressure chronic ulcer of left thigh with necrosis of muscle |
| L97124 | Non-pressure chronic ulcer of left thigh with necrosis of bone |
| L97125 | Non-pressure chronic ulcer of left thigh with muscle involvement without evidence of necrosis |
| L97126 | Non-pressure chronic ulcer of left thigh with bone involvement without evidence of necrosis |
| L97203 | Non-pressure chronic ulcer of unspecified calf with necrosis of muscle |
| L97204 | Non-pressure chronic ulcer of unspecified calf with necrosis of bone |
| L97205 | Non-pressure chronic ulcer of unspecified calf with muscle involvement without evidence of necrosis |
| L97206 | Non-pressure chronic ulcer of unspecified calf with bone involvement without evidence of necrosis |
| L97213 | Non-pressure chronic ulcer of right calf with necrosis of muscle |
| L97214 | Non-pressure chronic ulcer of right calf with necrosis of bone |
| L97215 | Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis |
| L97216 | Non-pressure chronic ulcer of right calf with bone involvement without evidence of necrosis |
| L97223 | Non-pressure chronic ulcer of left calf with necrosis of muscle |
| L97224 | Non-pressure chronic ulcer of left calf with necrosis of bone |
| L97225 | Non-pressure chronic ulcer of left calf with muscle involvement without evidence of necrosis |
| L97226 | Non-pressure chronic ulcer of left calf with bone involvement without evidence of necrosis |
| L97303 | Non-pressure chronic ulcer of unspecified ankle with necrosis of muscle |
| L97304 | Non-pressure chronic ulcer of unspecified ankle with necrosis of bone |
| L97305 | Non-pressure chronic ulcer of unspecified ankle with muscle involvement without evidence of necrosis |
| L97306 | Non-pressure chronic ulcer of unspecified ankle with bone involvement without evidence of necrosis |
| L97313 | Non-pressure chronic ulcer of right ankle with necrosis of muscle |
| L97314 | Non-pressure chronic ulcer of right ankle with necrosis of bone |
| L97315 | Non-pressure chronic ulcer of right ankle with muscle involvement without evidence of necrosis |
| L97316 | Non-pressure chronic ulcer of right ankle with bone involvement without evidence of necrosis |
| L97323 | Non-pressure chronic ulcer of left ankle with necrosis of muscle |
| L97324 | Non-pressure chronic ulcer of left ankle with necrosis of bone |
| L97325 | Non-pressure chronic ulcer of left ankle with muscle involvement without evidence of necrosis |
| L97326 | Non-pressure chronic ulcer of left ankle with bone involvement without evidence of necrosis |
| L97403 | Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of muscle |
| L97404 | Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of bone |
| L97405 | Non-pressure chronic ulcer of unspecified heel and midfoot with muscle involvement without evidence of necrosis |
| L97406 | Non-pressure chronic ulcer of unspecified heel and midfoot with bone involvement without evidence of necrosis |
| L97413 | Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle |
| L97414 | Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone |
| L97415 | Non-pressure chronic ulcer of right heel and midfoot with muscle involvement without evidence of necrosis |
| L97416 | Non-pressure chronic ulcer of right heel and midfoot with bone involvement without evidence of necrosis |
| L97423 | Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle |
| L97424 | Non-pressure chronic ulcer of left heel and midfoot with necrosis of bone |
| L97425 | Non-pressure chronic ulcer of left heel and midfoot with muscle involvement without evidence of necrosis |
| L97426 | Non-pressure chronic ulcer of left heel and midfoot with bone involvement without evidence of necrosis |
| L97503 | Non-pressure chronic ulcer of other part of unspecified foot with necrosis of muscle |
| L97504 | Non-pressure chronic ulcer of other part of unspecified foot with necrosis of bone |
| L97505 | Non-pressure chronic ulcer of other part of unspecified foot with muscle involvement without evidence of necrosis |
| L97506 | Non-pressure chronic ulcer of other part of unspecified foot with bone involvement without evidence of necrosis |
| L97513 | Non-pressure chronic ulcer of other part of right foot with necrosis of muscle |
| L97514 | Non-pressure chronic ulcer of other part of right foot with necrosis of bone |
| L97515 | Non-pressure chronic ulcer of other part of right foot with muscle involvement without evidence of necrosis |
| L97516 | Non-pressure chronic ulcer of other part of right foot with bone involvement without evidence of necrosis |
| L97523 | Non-pressure chronic ulcer of other part of left foot with necrosis of muscle |
| L97524 | Non-pressure chronic ulcer of other part of left foot with necrosis of bone |
| L97525 | Non-pressure chronic ulcer of other part of left foot with muscle involvement without evidence of necrosis |
| L97526 | Non-pressure chronic ulcer of other part of left foot with bone involvement without evidence of necrosis |
| L97803 | Non-pressure chronic ulcer of other part of unspecified lower leg with necrosis of muscle |
| L97804 | Non-pressure chronic ulcer of other part of unspecified lower leg with necrosis of bone |
| L97805 | Non-pressure chronic ulcer of other part of unspecified lower leg with muscle involvement without evidence of necrosis |
| L97806 | Non-pressure chronic ulcer of other part of unspecified lower leg with bone involvement without evidence of necrosis |
| L97813 | Non-pressure chronic ulcer of other part of right lower leg with necrosis of muscle |
| L97814 | Non-pressure chronic ulcer of other part of right lower leg with necrosis of bone |
| L97815 | Non-pressure chronic ulcer of other part of right lower leg with muscle involvement without evidence of necrosis |
| L97816 | Non-pressure chronic ulcer of other part of right lower leg with bone involvement without evidence of necrosis |
| L97823 | Non-pressure chronic ulcer of other part of left lower leg with necrosis of muscle |
| L97824 | Non-pressure chronic ulcer of other part of left lower leg with necrosis of bone |
| L97825 | Non-pressure chronic ulcer of other part of left lower leg with muscle involvement without evidence of necrosis |
| L97826 | Non-pressure chronic ulcer of other part of left lower leg with bone involvement without evidence of necrosis |
| L97903 | Non-pressure chronic ulcer of unspecified part of unspecified lower leg with necrosis of muscle |
| L97904 | Non-pressure chronic ulcer of unspecified part of unspecified lower leg with necrosis of bone |
| L97905 | Non-pressure chronic ulcer of unspecified part of unspecified lower leg with muscle involvement without evidence of necrosis |
| L97906 | Non-pressure chronic ulcer of unspecified part of unspecified lower leg with bone involvement without evidence of necrosis |
| L97913 | Non-pressure chronic ulcer of unspecified part of right lower leg with necrosis of muscle |
| L97914 | Non-pressure chronic ulcer of unspecified part of right lower leg with necrosis of bone |
| L97915 | Non-pressure chronic ulcer of unspecified part of right lower leg with muscle involvement without evidence of necrosis |
| L97916 | Non-pressure chronic ulcer of unspecified part of right lower leg with bone involvement without evidence of necrosis |
| L97923 | Non-pressure chronic ulcer of unspecified part of left lower leg with necrosis of muscle |
| L97924 | Non-pressure chronic ulcer of unspecified part of left lower leg with necrosis of bone |
| L97925 | Non-pressure chronic ulcer of unspecified part of left lower leg with muscle involvement without evidence of necrosis |
| L97926 | Non-pressure chronic ulcer of unspecified part of left lower leg with bone involvement without evidence of necrosis |
| L98413 | Non-pressure chronic ulcer of buttock with necrosis of muscle |
| L98414 | Non-pressure chronic ulcer of buttock with necrosis of bone |
| L98415 | Non-pressure chronic ulcer of buttock with muscle involvement without evidence of necrosis |
| L98416 | Non-pressure chronic ulcer of buttock with bone involvement without evidence of necrosis |
| L98423 | Non-pressure chronic ulcer of back with necrosis of muscle |
| L98424 | Non-pressure chronic ulcer of back with necrosis of bone |
| L98425 | Non-pressure chronic ulcer of back with muscle involvement without evidence of necrosis |
| L98426 | Non-pressure chronic ulcer of back with bone involvement without evidence of necrosis |
| L98433 | Non-pressure chronic ulcer of abdomen with necrosis of muscle |
| L98434 | Non-pressure chronic ulcer of abdomen with necrosis of bone |
| L98435 | Non-pressure chronic ulcer of abdomen with muscle involvement without evidence of necrosis |
| L98436 | Non-pressure chronic ulcer of abdomen with bone involvement without evidence of necrosis |
| L98443 | Non-pressure chronic ulcer of chest with necrosis of muscle |
| L98444 | Non-pressure chronic ulcer of chest with necrosis of bone |
| L98445 | Non-pressure chronic ulcer of chest with muscle involvement without evidence of necrosis |
| L98446 | Non-pressure chronic ulcer of chest with bone involvement without evidence of necrosis |
| L98453 | Non-pressure chronic ulcer of neck with necrosis of muscle |
| L98454 | Non-pressure chronic ulcer of neck with necrosis of bone |
| L98455 | Non-pressure chronic ulcer of neck with muscle involvement without evidence of necrosis |
| L98456 | Non-pressure chronic ulcer of neck with bone involvement without evidence of necrosis |
| L98463 | Non-pressure chronic ulcer of face with necrosis of muscle |
| L98464 | Non-pressure chronic ulcer of face with necrosis of bone |
| L98465 | Non-pressure chronic ulcer of face with muscle involvement without evidence of necrosis |
| L98466 | Non-pressure chronic ulcer of face with bone involvement without evidence of necrosis |
| L98473 | Non-pressure chronic ulcer of groin with necrosis of muscle |
| L98474 | Non-pressure chronic ulcer of groin with necrosis of bone |
| L98475 | Non-pressure chronic ulcer of groin with muscle involvement without evidence of necrosis |
| L98476 | Non-pressure chronic ulcer of groin with bone involvement without evidence of necrosis |
| L98493 | Non-pressure chronic ulcer of skin of other sites with necrosis of muscle |
| L98494 | Non-pressure chronic ulcer of skin of other sites with necrosis of bone |
| L98495 | Non-pressure chronic ulcer of skin of other sites with muscle involvement without evidence of necrosis |
| L98496 | Non-pressure chronic ulcer of skin of other sites with bone involvement without evidence of necrosis |
| L98A113 | Non-pressure chronic ulcer of right upper arm with necrosis of muscle |
| L98A114 | Non-pressure chronic ulcer of right upper arm with necrosis of bone |
| L98A115 | Non-pressure chronic ulcer of right upper arm with muscle involvement without evidence of necrosis |
| L98A116 | Non-pressure chronic ulcer of right upper arm with bone involvement without evidence of necrosis |
| L98A123 | Non-pressure chronic ulcer of left upper arm with necrosis of muscle |
| L98A124 | Non-pressure chronic ulcer of left upper arm with necrosis of bone |
| L98A125 | Non-pressure chronic ulcer of left upper arm with muscle involvement without evidence of necrosis |
| L98A126 | Non-pressure chronic ulcer of left upper arm with bone involvement without evidence of necrosis |
| L98A193 | Non-pressure chronic ulcer of unspecified upper arm with necrosis of muscle |
| L98A194 | Non-pressure chronic ulcer of unspecified upper arm with necrosis of bone |
| L98A195 | Non-pressure chronic ulcer of unspecified upper arm with muscle involvement without evidence of necrosis |
| L98A196 | Non-pressure chronic ulcer of unspecified upper arm with bone involvement without evidence of necrosis |
| L98A213 | Non-pressure chronic ulcer of right forearm with necrosis of muscle |
| L98A214 | Non-pressure chronic ulcer of right forearm with necrosis of bone |
| L98A215 | Non-pressure chronic ulcer of right forearm with muscle involvement without evidence of necrosis |
| L98A216 | Non-pressure chronic ulcer of right forearm with bone involvement without evidence of necrosis |
| L98A223 | Non-pressure chronic ulcer of left forearm with necrosis of muscle |
| L98A224 | Non-pressure chronic ulcer of left forearm with necrosis of bone |
| L98A225 | Non-pressure chronic ulcer of left forearm with muscle involvement without evidence of necrosis |
| L98A226 | Non-pressure chronic ulcer of left forearm with bone involvement without evidence of necrosis |
| L98A293 | Non-pressure chronic ulcer of unspecified forearm with necrosis of muscle |
| L98A294 | Non-pressure chronic ulcer of unspecified forearm with necrosis of bone |
| L98A295 | Non-pressure chronic ulcer of unspecified forearm with muscle involvement without evidence of necrosis |
| L98A296 | Non-pressure chronic ulcer of unspecified forearm with bone involvement without evidence of necrosis |
| L98A313 | Non-pressure chronic ulcer of right hand with necrosis of muscle |
| L98A314 | Non-pressure chronic ulcer of right hand with necrosis of bone |
| L98A315 | Non-pressure chronic ulcer of right hand with muscle involvement without evidence of necrosis |
| L98A316 | Non-pressure chronic ulcer of right hand with bone involvement without evidence of necrosis |
| L98A323 | Non-pressure chronic ulcer of left hand with necrosis of muscle |
| L98A324 | Non-pressure chronic ulcer of left hand with necrosis of bone |
| L98A325 | Non-pressure chronic ulcer of left hand with muscle involvement without evidence of necrosis |
| L98A326 | Non-pressure chronic ulcer of left hand with bone involvement without evidence of necrosis |
| L98A393 | Non-pressure chronic ulcer of unspecified hand with necrosis of muscle |
| L98A394 | Non-pressure chronic ulcer of unspecified hand with necrosis of bone |
| L98A395 | Non-pressure chronic ulcer of unspecified hand with muscle involvement without evidence of necrosis |
| L98A396 | Non-pressure chronic ulcer of unspecified hand with bone involvement without evidence of necrosis |
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 |
|---|---|
| 161 | 152 |
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 380?
152 ICD-10-CM codes map to HCC 380 in the CMS PY2027 initial mapping, for example L97103 Non-pressure chronic ulcer of unspecified thigh with necrosis of muscle; L97104 Non-pressure chronic ulcer of unspecified thigh with necrosis of bone; L97105 Non-pressure chronic ulcer of unspecified thigh with muscle involvement without evidence of necrosis; L97106 Non-pressure chronic ulcer of unspecified thigh with bone involvement without evidence of necrosis. 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 380 add to a risk score?
The V28 relative factor for HCC 380 is 1.078 for a community, non-dual, aged beneficiary, 1.422 for full-benefit dual aged, 1.091 for non-dual disabled and 0.839 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 380 count together with related categories?
No. Within a hierarchy only the most severe category is paid. HCC 380 is dropped when HCC 379 (Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone) is also present, and it drops HCC 381, HCC 382, HCC 383 when it is present.
What has to be documented for HCC 380 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.