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_HCC383 | 0.646 |
| Community, non-dual, disabled | CND_HCC383 | 0.707 |
| Community, full-benefit dual, aged | CFA_HCC383 | 0.890 |
| Community, full-benefit dual, disabled | CFD_HCC383 | 0.707 |
| Community, partial-benefit dual, aged | CPA_HCC383 | 0.660 |
| Community, partial-benefit dual, disabled | CPD_HCC383 | 0.654 |
| Long-term institutional | INS_HCC383 | 0.343 |
Hierarchy
Hierarchical condition categories pay only the most severe manifestation of a disease. When HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) or HCC 379 (Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone) or HCC 380 (Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle) or HCC 381 (Pressure Ulcer of Skin with Full Thickness Skin Loss) or HCC 382 (Pressure Ulcer of Skin with Partial Thickness Skin Loss) is also documented for the same beneficiary, HCC 383 is dropped from the score.
HCC 263
Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene · 127 codes · factor 1.118
HCC 379
Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone · 25 codes · factor 1.965
HCC 380
Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle · 152 codes · factor 1.078
HCC 381
Pressure Ulcer of Skin with Full Thickness Skin Loss · 50 codes · factor 1.075
ICD-10-CM codes that map to HCC 383
308 codes map to this category in the PY2027 initial mapping, concentrated in the I70 (90), L97 (84), L98 (68), I83 (42), I87 (16), E08 (2) 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 |
|---|---|
| E08621 | Diabetes mellitus due to underlying condition with foot ulcer |
| E08622 | Diabetes mellitus due to underlying condition with other skin ulcer |
| E10621 | Type 1 diabetes mellitus with foot ulcer |
| E10622 | Type 1 diabetes mellitus with other skin ulcer |
| E11621 | Type 2 diabetes mellitus with foot ulcer |
| E11622 | Type 2 diabetes mellitus with other skin ulcer |
| E13621 | Other specified diabetes mellitus with foot ulcer |
| E13622 | Other specified diabetes mellitus with other skin ulcer |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| I83001 | Varicose veins of unspecified lower extremity with ulcer of thigh |
| I83002 | Varicose veins of unspecified lower extremity with ulcer of calf |
| I83003 | Varicose veins of unspecified lower extremity with ulcer of ankle |
| I83004 | Varicose veins of unspecified lower extremity with ulcer of heel and midfoot |
| I83005 | Varicose veins of unspecified lower extremity with ulcer other part of foot |
| I83008 | Varicose veins of unspecified lower extremity with ulcer other part of lower leg |
| I83009 | Varicose veins of unspecified lower extremity with ulcer of unspecified site |
| I83011 | Varicose veins of right lower extremity with ulcer of thigh |
| I83012 | Varicose veins of right lower extremity with ulcer of calf |
| I83013 | Varicose veins of right lower extremity with ulcer of ankle |
| I83014 | Varicose veins of right lower extremity with ulcer of heel and midfoot |
| I83015 | Varicose veins of right lower extremity with ulcer other part of foot |
| I83018 | Varicose veins of right lower extremity with ulcer other part of lower leg |
| I83019 | Varicose veins of right lower extremity with ulcer of unspecified site |
| I83021 | Varicose veins of left lower extremity with ulcer of thigh |
| I83022 | Varicose veins of left lower extremity with ulcer of calf |
| I83023 | Varicose veins of left lower extremity with ulcer of ankle |
| I83024 | Varicose veins of left lower extremity with ulcer of heel and midfoot |
| I83025 | Varicose veins of left lower extremity with ulcer other part of foot |
| I83028 | Varicose veins of left lower extremity with ulcer other part of lower leg |
| I83029 | Varicose veins of left lower extremity with ulcer of unspecified site |
| I83201 | Varicose veins of unspecified lower extremity with both ulcer of thigh and inflammation |
| I83202 | Varicose veins of unspecified lower extremity with both ulcer of calf and inflammation |
| I83203 | Varicose veins of unspecified lower extremity with both ulcer of ankle and inflammation |
| I83204 | Varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation |
| I83205 | Varicose veins of unspecified lower extremity with both ulcer other part of foot and inflammation |
| I83208 | Varicose veins of unspecified lower extremity with both ulcer of other part of lower extremity and inflammation |
| I83209 | Varicose veins of unspecified lower extremity with both ulcer of unspecified site and inflammation |
| I83211 | Varicose veins of right lower extremity with both ulcer of thigh and inflammation |
| I83212 | Varicose veins of right lower extremity with both ulcer of calf and inflammation |
| I83213 | Varicose veins of right lower extremity with both ulcer of ankle and inflammation |
| I83214 | Varicose veins of right lower extremity with both ulcer of heel and midfoot and inflammation |
| I83215 | Varicose veins of right lower extremity with both ulcer other part of foot and inflammation |
| I83218 | Varicose veins of right lower extremity with both ulcer of other part of lower extremity and inflammation |
| I83219 | Varicose veins of right lower extremity with both ulcer of unspecified site and inflammation |
| I83221 | Varicose veins of left lower extremity with both ulcer of thigh and inflammation |
| I83222 | Varicose veins of left lower extremity with both ulcer of calf and inflammation |
| I83223 | Varicose veins of left lower extremity with both ulcer of ankle and inflammation |
| I83224 | Varicose veins of left lower extremity with both ulcer of heel and midfoot and inflammation |
| I83225 | Varicose veins of left lower extremity with both ulcer other part of foot and inflammation |
| I83228 | Varicose veins of left lower extremity with both ulcer of other part of lower extremity and inflammation |
| I83229 | Varicose veins of left lower extremity with both ulcer of unspecified site and inflammation |
| I87011 | Postthrombotic syndrome with ulcer of right lower extremity |
| I87012 | Postthrombotic syndrome with ulcer of left lower extremity |
| I87013 | Postthrombotic syndrome with ulcer of bilateral lower extremity |
| I87019 | Postthrombotic syndrome with ulcer of unspecified lower extremity |
| I87031 | Postthrombotic syndrome with ulcer and inflammation of right lower extremity |
| I87032 | Postthrombotic syndrome with ulcer and inflammation of left lower extremity |
| I87033 | Postthrombotic syndrome with ulcer and inflammation of bilateral lower extremity |
| I87039 | Postthrombotic syndrome with ulcer and inflammation of unspecified lower extremity |
| I87311 | Chronic venous hypertension (idiopathic) with ulcer of right lower extremity |
| I87312 | Chronic venous hypertension (idiopathic) with ulcer of left lower extremity |
| I87313 | Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity |
| I87319 | Chronic venous hypertension (idiopathic) with ulcer of unspecified lower extremity |
| I87331 | Chronic venous hypertension (idiopathic) with ulcer and inflammation of right lower extremity |
| I87332 | Chronic venous hypertension (idiopathic) with ulcer and inflammation of left lower extremity |
| I87333 | Chronic venous hypertension (idiopathic) with ulcer and inflammation of bilateral lower extremity |
| I87339 | Chronic venous hypertension (idiopathic) with ulcer and inflammation of unspecified lower extremity |
| L97101 | Non-pressure chronic ulcer of unspecified thigh limited to breakdown of skin |
| L97102 | Non-pressure chronic ulcer of unspecified thigh with fat layer exposed |
| L97108 | Non-pressure chronic ulcer of unspecified thigh with other specified severity |
| L97109 | Non-pressure chronic ulcer of unspecified thigh with unspecified severity |
| L97111 | Non-pressure chronic ulcer of right thigh limited to breakdown of skin |
| L97112 | Non-pressure chronic ulcer of right thigh with fat layer exposed |
| L97118 | Non-pressure chronic ulcer of right thigh with other specified severity |
| L97119 | Non-pressure chronic ulcer of right thigh with unspecified severity |
| L97121 | Non-pressure chronic ulcer of left thigh limited to breakdown of skin |
| L97122 | Non-pressure chronic ulcer of left thigh with fat layer exposed |
| L97128 | Non-pressure chronic ulcer of left thigh with other specified severity |
| L97129 | Non-pressure chronic ulcer of left thigh with unspecified severity |
| L97201 | Non-pressure chronic ulcer of unspecified calf limited to breakdown of skin |
| L97202 | Non-pressure chronic ulcer of unspecified calf with fat layer exposed |
| L97208 | Non-pressure chronic ulcer of unspecified calf with other specified severity |
| L97209 | Non-pressure chronic ulcer of unspecified calf with unspecified severity |
| L97211 | Non-pressure chronic ulcer of right calf limited to breakdown of skin |
| L97212 | Non-pressure chronic ulcer of right calf with fat layer exposed |
| L97218 | Non-pressure chronic ulcer of right calf with other specified severity |
| L97219 | Non-pressure chronic ulcer of right calf with unspecified severity |
| L97221 | Non-pressure chronic ulcer of left calf limited to breakdown of skin |
| L97222 | Non-pressure chronic ulcer of left calf with fat layer exposed |
| L97228 | Non-pressure chronic ulcer of left calf with other specified severity |
| L97229 | Non-pressure chronic ulcer of left calf with unspecified severity |
| L97301 | Non-pressure chronic ulcer of unspecified ankle limited to breakdown of skin |
| L97302 | Non-pressure chronic ulcer of unspecified ankle with fat layer exposed |
| L97308 | Non-pressure chronic ulcer of unspecified ankle with other specified severity |
| L97309 | Non-pressure chronic ulcer of unspecified ankle with unspecified severity |
| L97311 | Non-pressure chronic ulcer of right ankle limited to breakdown of skin |
| L97312 | Non-pressure chronic ulcer of right ankle with fat layer exposed |
| L97318 | Non-pressure chronic ulcer of right ankle with other specified severity |
| L97319 | Non-pressure chronic ulcer of right ankle with unspecified severity |
| L97321 | Non-pressure chronic ulcer of left ankle limited to breakdown of skin |
| L97322 | Non-pressure chronic ulcer of left ankle with fat layer exposed |
| L97328 | Non-pressure chronic ulcer of left ankle with other specified severity |
| L97329 | Non-pressure chronic ulcer of left ankle with unspecified severity |
| L97401 | Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin |
| L97402 | Non-pressure chronic ulcer of unspecified heel and midfoot with fat layer exposed |
| L97408 | Non-pressure chronic ulcer of unspecified heel and midfoot with other specified severity |
| L97409 | Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified severity |
| L97411 | Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of skin |
| L97412 | Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed |
| L97418 | Non-pressure chronic ulcer of right heel and midfoot with other specified severity |
| L97419 | Non-pressure chronic ulcer of right heel and midfoot with unspecified severity |
| L97421 | Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin |
| L97422 | Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed |
| L97428 | Non-pressure chronic ulcer of left heel and midfoot with other specified severity |
| L97429 | Non-pressure chronic ulcer of left heel and midfoot with unspecified severity |
| L97501 | Non-pressure chronic ulcer of other part of unspecified foot limited to breakdown of skin |
| L97502 | Non-pressure chronic ulcer of other part of unspecified foot with fat layer exposed |
| L97508 | Non-pressure chronic ulcer of other part of unspecified foot with other specified severity |
| L97509 | Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity |
| L97511 | Non-pressure chronic ulcer of other part of right foot limited to breakdown of skin |
| L97512 | Non-pressure chronic ulcer of other part of right foot with fat layer exposed |
| L97518 | Non-pressure chronic ulcer of other part of right foot with other specified severity |
| L97519 | Non-pressure chronic ulcer of other part of right foot with unspecified severity |
| L97521 | Non-pressure chronic ulcer of other part of left foot limited to breakdown of skin |
| L97522 | Non-pressure chronic ulcer of other part of left foot with fat layer exposed |
| L97528 | Non-pressure chronic ulcer of other part of left foot with other specified severity |
| L97529 | Non-pressure chronic ulcer of other part of left foot with unspecified severity |
| L97801 | Non-pressure chronic ulcer of other part of unspecified lower leg limited to breakdown of skin |
| L97802 | Non-pressure chronic ulcer of other part of unspecified lower leg with fat layer exposed |
| L97808 | Non-pressure chronic ulcer of other part of unspecified lower leg with other specified severity |
| L97809 | Non-pressure chronic ulcer of other part of unspecified lower leg with unspecified severity |
| L97811 | Non-pressure chronic ulcer of other part of right lower leg limited to breakdown of skin |
| L97812 | Non-pressure chronic ulcer of other part of right lower leg with fat layer exposed |
| L97818 | Non-pressure chronic ulcer of other part of right lower leg with other specified severity |
| L97819 | Non-pressure chronic ulcer of other part of right lower leg with unspecified severity |
| L97821 | Non-pressure chronic ulcer of other part of left lower leg limited to breakdown of skin |
| L97822 | Non-pressure chronic ulcer of other part of left lower leg with fat layer exposed |
| L97828 | Non-pressure chronic ulcer of other part of left lower leg with other specified severity |
| L97829 | Non-pressure chronic ulcer of other part of left lower leg with unspecified severity |
| L97901 | Non-pressure chronic ulcer of unspecified part of unspecified lower leg limited to breakdown of skin |
| L97902 | Non-pressure chronic ulcer of unspecified part of unspecified lower leg with fat layer exposed |
| L97908 | Non-pressure chronic ulcer of unspecified part of unspecified lower leg with other specified severity |
| L97909 | Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity |
| L97911 | Non-pressure chronic ulcer of unspecified part of right lower leg limited to breakdown of skin |
| L97912 | Non-pressure chronic ulcer of unspecified part of right lower leg with fat layer exposed |
| L97918 | Non-pressure chronic ulcer of unspecified part of right lower leg with other specified severity |
| L97919 | Non-pressure chronic ulcer of unspecified part of right lower leg with unspecified severity |
| L97921 | Non-pressure chronic ulcer of unspecified part of left lower leg limited to breakdown of skin |
| L97922 | Non-pressure chronic ulcer of unspecified part of left lower leg with fat layer exposed |
| L97928 | Non-pressure chronic ulcer of unspecified part of left lower leg with other specified severity |
| L97929 | Non-pressure chronic ulcer of unspecified part of left lower leg with unspecified severity |
| L98411 | Non-pressure chronic ulcer of buttock limited to breakdown of skin |
| L98412 | Non-pressure chronic ulcer of buttock with fat layer exposed |
| L98418 | Non-pressure chronic ulcer of buttock with other specified severity |
| L98419 | Non-pressure chronic ulcer of buttock with unspecified severity |
| L98421 | Non-pressure chronic ulcer of back limited to breakdown of skin |
| L98422 | Non-pressure chronic ulcer of back with fat layer exposed |
| L98428 | Non-pressure chronic ulcer of back with other specified severity |
| L98429 | Non-pressure chronic ulcer of back with unspecified severity |
| L98431 | Non-pressure chronic ulcer of abdomen limited to breakdown of skin |
| L98432 | Non-pressure chronic ulcer of abdomen with fat layer exposed |
| L98438 | Non-pressure chronic ulcer of abdomen with other specified severity |
| L98439 | Non-pressure chronic ulcer of abdomen with unspecified severity |
| L98441 | Non-pressure chronic ulcer of chest limited to breakdown of skin |
| L98442 | Non-pressure chronic ulcer of chest with fat layer exposed |
| L98448 | Non-pressure chronic ulcer of chest with other specified severity |
| L98449 | Non-pressure chronic ulcer of chest with unspecified severity |
| L98451 | Non-pressure chronic ulcer of neck limited to breakdown of skin |
| L98452 | Non-pressure chronic ulcer of neck with fat layer exposed |
| L98458 | Non-pressure chronic ulcer of neck with other specified severity |
| L98459 | Non-pressure chronic ulcer of neck with unspecified severity |
| L98461 | Non-pressure chronic ulcer of face limited to breakdown of skin |
| L98462 | Non-pressure chronic ulcer of face with fat layer exposed |
| L98468 | Non-pressure chronic ulcer of face with other specified severity |
| L98469 | Non-pressure chronic ulcer of face with unspecified severity |
| L98471 | Non-pressure chronic ulcer of groin limited to breakdown of skin |
| L98472 | Non-pressure chronic ulcer of groin with fat layer exposed |
| L98478 | Non-pressure chronic ulcer of groin with other specified severity |
| L98479 | Non-pressure chronic ulcer of groin with unspecified severity |
| L98491 | Non-pressure chronic ulcer of skin of other sites limited to breakdown of skin |
| L98492 | Non-pressure chronic ulcer of skin of other sites with fat layer exposed |
| L98498 | Non-pressure chronic ulcer of skin of other sites with other specified severity |
| L98499 | Non-pressure chronic ulcer of skin of other sites with unspecified severity |
| L98A111 | Non-pressure chronic ulcer of right upper arm limited to breakdown of skin |
| L98A112 | Non-pressure chronic ulcer of right upper arm with fat layer exposed |
| L98A118 | Non-pressure chronic ulcer of right upper arm with other specified severity |
| L98A119 | Non-pressure chronic ulcer of right upper arm with unspecified severity |
| L98A121 | Non-pressure chronic ulcer of left upper arm limited to breakdown of skin |
| L98A122 | Non-pressure chronic ulcer of left upper arm with fat layer exposed |
| L98A128 | Non-pressure chronic ulcer of left upper arm with other specified severity |
| L98A129 | Non-pressure chronic ulcer of left upper arm with unspecified severity |
| L98A191 | Non-pressure chronic ulcer of unspecified upper arm limited to breakdown of skin |
| L98A192 | Non-pressure chronic ulcer of unspecified upper arm with fat layer exposed |
| L98A198 | Non-pressure chronic ulcer of unspecified upper arm with other specified severity |
| L98A199 | Non-pressure chronic ulcer of unspecified upper arm with unspecified severity |
| L98A211 | Non-pressure chronic ulcer of right forearm limited to breakdown of skin |
| L98A212 | Non-pressure chronic ulcer of right forearm with fat layer exposed |
| L98A218 | Non-pressure chronic ulcer of right forearm with other specified severity |
| L98A219 | Non-pressure chronic ulcer of right forearm with unspecified severity |
| L98A221 | Non-pressure chronic ulcer of left forearm limited to breakdown of skin |
| L98A222 | Non-pressure chronic ulcer of left forearm with fat layer exposed |
| L98A228 | Non-pressure chronic ulcer of left forearm with other specified severity |
| L98A229 | Non-pressure chronic ulcer of left forearm with unspecified severity |
| L98A291 | Non-pressure chronic ulcer of unspecified forearm limited to breakdown of skin |
| L98A292 | Non-pressure chronic ulcer of unspecified forearm with fat layer exposed |
| L98A298 | Non-pressure chronic ulcer of unspecified forearm with other specified severity |
| L98A299 | Non-pressure chronic ulcer of unspecified forearm with unspecified severity |
| L98A311 | Non-pressure chronic ulcer of right hand limited to breakdown of skin |
| L98A312 | Non-pressure chronic ulcer of right hand with fat layer exposed |
| L98A318 | Non-pressure chronic ulcer of right hand with other specified severity |
| L98A319 | Non-pressure chronic ulcer of right hand with unspecified severity |
| L98A321 | Non-pressure chronic ulcer of left hand limited to breakdown of skin |
| L98A322 | Non-pressure chronic ulcer of left hand with fat layer exposed |
| L98A328 | Non-pressure chronic ulcer of left hand with other specified severity |
| L98A329 | Non-pressure chronic ulcer of left hand with unspecified severity |
| L98A391 | Non-pressure chronic ulcer of unspecified hand limited to breakdown of skin |
| L98A392 | Non-pressure chronic ulcer of unspecified hand with fat layer exposed |
| L98A398 | Non-pressure chronic ulcer of unspecified hand with other specified severity |
| L98A399 | Non-pressure chronic ulcer of unspecified hand with unspecified severity |
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 | 250 |
| 107 | 58 |
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 383?
308 ICD-10-CM codes map to HCC 383 in the CMS PY2027 initial mapping, for example E08621 Diabetes mellitus due to underlying condition with foot ulcer; E08622 Diabetes mellitus due to underlying condition with other skin ulcer; E10621 Type 1 diabetes mellitus with foot ulcer; E10622 Type 1 diabetes mellitus with other skin ulcer. 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 383 add to a risk score?
The V28 relative factor for HCC 383 is 0.646 for a community, non-dual, aged beneficiary, 0.890 for full-benefit dual aged, 0.707 for non-dual disabled and 0.343 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 383 count together with related categories?
No. Within a hierarchy only the most severe category is paid. HCC 383 is dropped when HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) or HCC 379 (Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone) or HCC 380 (Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle) or HCC 381 (Pressure Ulcer of Skin with Full Thickness Skin Loss) or HCC 382 (Pressure Ulcer of Skin with Partial Thickness Skin Loss) is also present.
What has to be documented for HCC 383 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.