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_HCC92 | 0.479 |
| Community, non-dual, disabled | CND_HCC92 | 0.529 |
| Community, full-benefit dual, aged | CFA_HCC92 | 0.611 |
| Community, full-benefit dual, disabled | CFD_HCC92 | 0.632 |
| Community, partial-benefit dual, aged | CPA_HCC92 | 0.471 |
| Community, partial-benefit dual, disabled | CPD_HCC92 | 0.539 |
| Long-term institutional | INS_HCC92 | 0.556 |
Hierarchy
HCC 92 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 92
609 codes map to this category in the PY2027 initial mapping, concentrated in the M86 (179), M87 (173), M00 (97), M02 (49), M01 (24), M89 (24) 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 |
|---|---|
| A0104 | Typhoid arthritis |
| A0105 | Typhoid osteomyelitis |
| A0223 | Salmonella arthritis |
| A0224 | Salmonella osteomyelitis |
| A3983 | Meningococcal arthritis |
| A3984 | Postmeningococcal arthritis |
| A5055 | Late congenital syphilitic arthropathy |
| A5440 | Gonococcal infection of musculoskeletal system, unspecified |
| A5441 | Gonococcal spondylopathy |
| A5442 | Gonococcal arthritis |
| A5443 | Gonococcal osteomyelitis |
| A5449 | Gonococcal infection of other musculoskeletal tissue |
| A666 | Bone and joint lesions of yaws |
| A6923 | Arthritis due to Lyme disease |
| B0682 | Rubella arthritis |
| B2685 | Mumps arthritis |
| B4282 | Sporotrichosis arthritis |
| M0000 | Staphylococcal arthritis, unspecified joint |
| M00011 | Staphylococcal arthritis, right shoulder |
| M00012 | Staphylococcal arthritis, left shoulder |
| M00019 | Staphylococcal arthritis, unspecified shoulder |
| M00021 | Staphylococcal arthritis, right elbow |
| M00022 | Staphylococcal arthritis, left elbow |
| M00029 | Staphylococcal arthritis, unspecified elbow |
| M00031 | Staphylococcal arthritis, right wrist |
| M00032 | Staphylococcal arthritis, left wrist |
| M00039 | Staphylococcal arthritis, unspecified wrist |
| M00041 | Staphylococcal arthritis, right hand |
| M00042 | Staphylococcal arthritis, left hand |
| M00049 | Staphylococcal arthritis, unspecified hand |
| M00051 | Staphylococcal arthritis, right hip |
| M00052 | Staphylococcal arthritis, left hip |
| M00059 | Staphylococcal arthritis, unspecified hip |
| M00061 | Staphylococcal arthritis, right knee |
| M00062 | Staphylococcal arthritis, left knee |
| M00069 | Staphylococcal arthritis, unspecified knee |
| M00071 | Staphylococcal arthritis, right ankle and foot |
| M00072 | Staphylococcal arthritis, left ankle and foot |
| M00079 | Staphylococcal arthritis, unspecified ankle and foot |
| M0008 | Staphylococcal arthritis, vertebrae |
| M0009 | Staphylococcal polyarthritis |
| M0010 | Pneumococcal arthritis, unspecified joint |
| M00111 | Pneumococcal arthritis, right shoulder |
| M00112 | Pneumococcal arthritis, left shoulder |
| M00119 | Pneumococcal arthritis, unspecified shoulder |
| M00121 | Pneumococcal arthritis, right elbow |
| M00122 | Pneumococcal arthritis, left elbow |
| M00129 | Pneumococcal arthritis, unspecified elbow |
| M00131 | Pneumococcal arthritis, right wrist |
| M00132 | Pneumococcal arthritis, left wrist |
| M00139 | Pneumococcal arthritis, unspecified wrist |
| M00141 | Pneumococcal arthritis, right hand |
| M00142 | Pneumococcal arthritis, left hand |
| M00149 | Pneumococcal arthritis, unspecified hand |
| M00151 | Pneumococcal arthritis, right hip |
| M00152 | Pneumococcal arthritis, left hip |
| M00159 | Pneumococcal arthritis, unspecified hip |
| M00161 | Pneumococcal arthritis, right knee |
| M00162 | Pneumococcal arthritis, left knee |
| M00169 | Pneumococcal arthritis, unspecified knee |
| M00171 | Pneumococcal arthritis, right ankle and foot |
| M00172 | Pneumococcal arthritis, left ankle and foot |
| M00179 | Pneumococcal arthritis, unspecified ankle and foot |
| M0018 | Pneumococcal arthritis, vertebrae |
| M0019 | Pneumococcal polyarthritis |
| M0020 | Other streptococcal arthritis, unspecified joint |
| M00211 | Other streptococcal arthritis, right shoulder |
| M00212 | Other streptococcal arthritis, left shoulder |
| M00219 | Other streptococcal arthritis, unspecified shoulder |
| M00221 | Other streptococcal arthritis, right elbow |
| M00222 | Other streptococcal arthritis, left elbow |
| M00229 | Other streptococcal arthritis, unspecified elbow |
| M00231 | Other streptococcal arthritis, right wrist |
| M00232 | Other streptococcal arthritis, left wrist |
| M00239 | Other streptococcal arthritis, unspecified wrist |
| M00241 | Other streptococcal arthritis, right hand |
| M00242 | Other streptococcal arthritis, left hand |
| M00249 | Other streptococcal arthritis, unspecified hand |
| M00251 | Other streptococcal arthritis, right hip |
| M00252 | Other streptococcal arthritis, left hip |
| M00259 | Other streptococcal arthritis, unspecified hip |
| M00261 | Other streptococcal arthritis, right knee |
| M00262 | Other streptococcal arthritis, left knee |
| M00269 | Other streptococcal arthritis, unspecified knee |
| M00271 | Other streptococcal arthritis, right ankle and foot |
| M00272 | Other streptococcal arthritis, left ankle and foot |
| M00279 | Other streptococcal arthritis, unspecified ankle and foot |
| M0028 | Other streptococcal arthritis, vertebrae |
| M0029 | Other streptococcal polyarthritis |
| M0080 | Arthritis due to other bacteria, unspecified joint |
| M00811 | Arthritis due to other bacteria, right shoulder |
| M00812 | Arthritis due to other bacteria, left shoulder |
| M00819 | Arthritis due to other bacteria, unspecified shoulder |
| M00821 | Arthritis due to other bacteria, right elbow |
| M00822 | Arthritis due to other bacteria, left elbow |
| M00829 | Arthritis due to other bacteria, unspecified elbow |
| M00831 | Arthritis due to other bacteria, right wrist |
| M00832 | Arthritis due to other bacteria, left wrist |
| M00839 | Arthritis due to other bacteria, unspecified wrist |
| M00841 | Arthritis due to other bacteria, right hand |
| M00842 | Arthritis due to other bacteria, left hand |
| M00849 | Arthritis due to other bacteria, unspecified hand |
| M00851 | Arthritis due to other bacteria, right hip |
| M00852 | Arthritis due to other bacteria, left hip |
| M00859 | Arthritis due to other bacteria, unspecified hip |
| M00861 | Arthritis due to other bacteria, right knee |
| M00862 | Arthritis due to other bacteria, left knee |
| M00869 | Arthritis due to other bacteria, unspecified knee |
| M00871 | Arthritis due to other bacteria, right ankle and foot |
| M00872 | Arthritis due to other bacteria, left ankle and foot |
| M00879 | Arthritis due to other bacteria, unspecified ankle and foot |
| M0088 | Arthritis due to other bacteria, vertebrae |
| M0089 | Polyarthritis due to other bacteria |
| M009 | Pyogenic arthritis, unspecified |
| M01X0 | Direct infection of unspecified joint in infectious and parasitic diseases classified elsewhere |
| M01X11 | Direct infection of right shoulder in infectious and parasitic diseases classified elsewhere |
| M01X12 | Direct infection of left shoulder in infectious and parasitic diseases classified elsewhere |
| M01X19 | Direct infection of unspecified shoulder in infectious and parasitic diseases classified elsewhere |
| M01X21 | Direct infection of right elbow in infectious and parasitic diseases classified elsewhere |
| M01X22 | Direct infection of left elbow in infectious and parasitic diseases classified elsewhere |
| M01X29 | Direct infection of unspecified elbow in infectious and parasitic diseases classified elsewhere |
| M01X31 | Direct infection of right wrist in infectious and parasitic diseases classified elsewhere |
| M01X32 | Direct infection of left wrist in infectious and parasitic diseases classified elsewhere |
| M01X39 | Direct infection of unspecified wrist in infectious and parasitic diseases classified elsewhere |
| M01X41 | Direct infection of right hand in infectious and parasitic diseases classified elsewhere |
| M01X42 | Direct infection of left hand in infectious and parasitic diseases classified elsewhere |
| M01X49 | Direct infection of unspecified hand in infectious and parasitic diseases classified elsewhere |
| M01X51 | Direct infection of right hip in infectious and parasitic diseases classified elsewhere |
| M01X52 | Direct infection of left hip in infectious and parasitic diseases classified elsewhere |
| M01X59 | Direct infection of unspecified hip in infectious and parasitic diseases classified elsewhere |
| M01X61 | Direct infection of right knee in infectious and parasitic diseases classified elsewhere |
| M01X62 | Direct infection of left knee in infectious and parasitic diseases classified elsewhere |
| M01X69 | Direct infection of unspecified knee in infectious and parasitic diseases classified elsewhere |
| M01X71 | Direct infection of right ankle and foot in infectious and parasitic diseases classified elsewhere |
| M01X72 | Direct infection of left ankle and foot in infectious and parasitic diseases classified elsewhere |
| M01X79 | Direct infection of unspecified ankle and foot in infectious and parasitic diseases classified elsewhere |
| M01X8 | Direct infection of vertebrae in infectious and parasitic diseases classified elsewhere |
| M01X9 | Direct infection of multiple joints in infectious and parasitic diseases classified elsewhere |
| M0210 | Postdysenteric arthropathy, unspecified site |
| M02111 | Postdysenteric arthropathy, right shoulder |
| M02112 | Postdysenteric arthropathy, left shoulder |
| M02119 | Postdysenteric arthropathy, unspecified shoulder |
| M02121 | Postdysenteric arthropathy, right elbow |
| M02122 | Postdysenteric arthropathy, left elbow |
| M02129 | Postdysenteric arthropathy, unspecified elbow |
| M02131 | Postdysenteric arthropathy, right wrist |
| M02132 | Postdysenteric arthropathy, left wrist |
| M02139 | Postdysenteric arthropathy, unspecified wrist |
| M02141 | Postdysenteric arthropathy, right hand |
| M02142 | Postdysenteric arthropathy, left hand |
| M02149 | Postdysenteric arthropathy, unspecified hand |
| M02151 | Postdysenteric arthropathy, right hip |
| M02152 | Postdysenteric arthropathy, left hip |
| M02159 | Postdysenteric arthropathy, unspecified hip |
| M02161 | Postdysenteric arthropathy, right knee |
| M02162 | Postdysenteric arthropathy, left knee |
| M02169 | Postdysenteric arthropathy, unspecified knee |
| M02171 | Postdysenteric arthropathy, right ankle and foot |
| M02172 | Postdysenteric arthropathy, left ankle and foot |
| M02179 | Postdysenteric arthropathy, unspecified ankle and foot |
| M0218 | Postdysenteric arthropathy, vertebrae |
| M0219 | Postdysenteric arthropathy, multiple sites |
| M0280 | Other reactive arthropathies, unspecified site |
| M02811 | Other reactive arthropathies, right shoulder |
| M02812 | Other reactive arthropathies, left shoulder |
| M02819 | Other reactive arthropathies, unspecified shoulder |
| M02821 | Other reactive arthropathies, right elbow |
| M02822 | Other reactive arthropathies, left elbow |
| M02829 | Other reactive arthropathies, unspecified elbow |
| M02831 | Other reactive arthropathies, right wrist |
| M02832 | Other reactive arthropathies, left wrist |
| M02839 | Other reactive arthropathies, unspecified wrist |
| M02841 | Other reactive arthropathies, right hand |
| M02842 | Other reactive arthropathies, left hand |
| M02849 | Other reactive arthropathies, unspecified hand |
| M02851 | Other reactive arthropathies, right hip |
| M02852 | Other reactive arthropathies, left hip |
| M02859 | Other reactive arthropathies, unspecified hip |
| M02861 | Other reactive arthropathies, right knee |
| M02862 | Other reactive arthropathies, left knee |
| M02869 | Other reactive arthropathies, unspecified knee |
| M02871 | Other reactive arthropathies, right ankle and foot |
| M02872 | Other reactive arthropathies, left ankle and foot |
| M02879 | Other reactive arthropathies, unspecified ankle and foot |
| M0288 | Other reactive arthropathies, vertebrae |
| M0289 | Other reactive arthropathies, multiple sites |
| M029 | Reactive arthropathy, unspecified |
| M4620 | Osteomyelitis of vertebra, site unspecified |
| M4621 | Osteomyelitis of vertebra, occipito-atlanto-axial region |
| M4622 | Osteomyelitis of vertebra, cervical region |
| M4623 | Osteomyelitis of vertebra, cervicothoracic region |
| M4624 | Osteomyelitis of vertebra, thoracic region |
| M4625 | Osteomyelitis of vertebra, thoracolumbar region |
| M4626 | Osteomyelitis of vertebra, lumbar region |
| M4627 | Osteomyelitis of vertebra, lumbosacral region |
| M4628 | Osteomyelitis of vertebra, sacral and sacrococcygeal region |
| M4630 | Infection of intervertebral disc (pyogenic), site unspecified |
| M4631 | Infection of intervertebral disc (pyogenic), occipito-atlanto-axial region |
| M4632 | Infection of intervertebral disc (pyogenic), cervical region |
| M4633 | Infection of intervertebral disc (pyogenic), cervicothoracic region |
| M4634 | Infection of intervertebral disc (pyogenic), thoracic region |
| M4635 | Infection of intervertebral disc (pyogenic), thoracolumbar region |
| M4636 | Infection of intervertebral disc (pyogenic), lumbar region |
| M4637 | Infection of intervertebral disc (pyogenic), lumbosacral region |
| M4638 | Infection of intervertebral disc (pyogenic), sacral and sacrococcygeal region |
| M4639 | Infection of intervertebral disc (pyogenic), multiple sites in spine |
| M726 | Necrotizing fasciitis |
| M8600 | Acute hematogenous osteomyelitis, unspecified site |
| M86011 | Acute hematogenous osteomyelitis, right shoulder |
| M86012 | Acute hematogenous osteomyelitis, left shoulder |
| M86019 | Acute hematogenous osteomyelitis, unspecified shoulder |
| M86021 | Acute hematogenous osteomyelitis, right humerus |
| M86022 | Acute hematogenous osteomyelitis, left humerus |
| M86029 | Acute hematogenous osteomyelitis, unspecified humerus |
| M86031 | Acute hematogenous osteomyelitis, right radius and ulna |
| M86032 | Acute hematogenous osteomyelitis, left radius and ulna |
| M86039 | Acute hematogenous osteomyelitis, unspecified radius and ulna |
| M86041 | Acute hematogenous osteomyelitis, right hand |
| M86042 | Acute hematogenous osteomyelitis, left hand |
| M86049 | Acute hematogenous osteomyelitis, unspecified hand |
| M86051 | Acute hematogenous osteomyelitis, right femur |
| M86052 | Acute hematogenous osteomyelitis, left femur |
| M86059 | Acute hematogenous osteomyelitis, unspecified femur |
| M86061 | Acute hematogenous osteomyelitis, right tibia and fibula |
| M86062 | Acute hematogenous osteomyelitis, left tibia and fibula |
| M86069 | Acute hematogenous osteomyelitis, unspecified tibia and fibula |
| M86071 | Acute hematogenous osteomyelitis, right ankle and foot |
| M86072 | Acute hematogenous osteomyelitis, left ankle and foot |
| M86079 | Acute hematogenous osteomyelitis, unspecified ankle and foot |
| M8608 | Acute hematogenous osteomyelitis, other sites |
| M8609 | Acute hematogenous osteomyelitis, multiple sites |
| M8610 | Other acute osteomyelitis, unspecified site |
| M86111 | Other acute osteomyelitis, right shoulder |
| M86112 | Other acute osteomyelitis, left shoulder |
| M86119 | Other acute osteomyelitis, unspecified shoulder |
| M86121 | Other acute osteomyelitis, right humerus |
| M86122 | Other acute osteomyelitis, left humerus |
| M86129 | Other acute osteomyelitis, unspecified humerus |
| M86131 | Other acute osteomyelitis, right radius and ulna |
| M86132 | Other acute osteomyelitis, left radius and ulna |
| M86139 | Other acute osteomyelitis, unspecified radius and ulna |
| M86141 | Other acute osteomyelitis, right hand |
| M86142 | Other acute osteomyelitis, left hand |
| M86149 | Other acute osteomyelitis, unspecified hand |
| M86151 | Other acute osteomyelitis, right femur |
| M86152 | Other acute osteomyelitis, left femur |
| M86159 | Other acute osteomyelitis, unspecified femur |
| M86161 | Other acute osteomyelitis, right tibia and fibula |
| M86162 | Other acute osteomyelitis, left tibia and fibula |
| M86169 | Other acute osteomyelitis, unspecified tibia and fibula |
| M86171 | Other acute osteomyelitis, right ankle and foot |
| M86172 | Other acute osteomyelitis, left ankle and foot |
| M86179 | Other acute osteomyelitis, unspecified ankle and foot |
| M8618 | Other acute osteomyelitis, other site |
| M8619 | Other acute osteomyelitis, multiple sites |
| M8620 | Subacute osteomyelitis, unspecified site |
| M86211 | Subacute osteomyelitis, right shoulder |
| M86212 | Subacute osteomyelitis, left shoulder |
| M86219 | Subacute osteomyelitis, unspecified shoulder |
| M86221 | Subacute osteomyelitis, right humerus |
| M86222 | Subacute osteomyelitis, left humerus |
| M86229 | Subacute osteomyelitis, unspecified humerus |
| M86231 | Subacute osteomyelitis, right radius and ulna |
| M86232 | Subacute osteomyelitis, left radius and ulna |
| M86239 | Subacute osteomyelitis, unspecified radius and ulna |
| M86241 | Subacute osteomyelitis, right hand |
| M86242 | Subacute osteomyelitis, left hand |
| M86249 | Subacute osteomyelitis, unspecified hand |
| M86251 | Subacute osteomyelitis, right femur |
| M86252 | Subacute osteomyelitis, left femur |
| M86259 | Subacute osteomyelitis, unspecified femur |
| M86261 | Subacute osteomyelitis, right tibia and fibula |
| M86262 | Subacute osteomyelitis, left tibia and fibula |
| M86269 | Subacute osteomyelitis, unspecified tibia and fibula |
| M86271 | Subacute osteomyelitis, right ankle and foot |
| M86272 | Subacute osteomyelitis, left ankle and foot |
| M86279 | Subacute osteomyelitis, unspecified ankle and foot |
| M8628 | Subacute osteomyelitis, other site |
| M8629 | Subacute osteomyelitis, multiple sites |
| M8630 | Chronic multifocal osteomyelitis, unspecified site |
| M86311 | Chronic multifocal osteomyelitis, right shoulder |
| M86312 | Chronic multifocal osteomyelitis, left shoulder |
| M86319 | Chronic multifocal osteomyelitis, unspecified shoulder |
| M86321 | Chronic multifocal osteomyelitis, right humerus |
| M86322 | Chronic multifocal osteomyelitis, left humerus |
| M86329 | Chronic multifocal osteomyelitis, unspecified humerus |
| M86331 | Chronic multifocal osteomyelitis, right radius and ulna |
| M86332 | Chronic multifocal osteomyelitis, left radius and ulna |
| M86339 | Chronic multifocal osteomyelitis, unspecified radius and ulna |
| M86341 | Chronic multifocal osteomyelitis, right hand |
| M86342 | Chronic multifocal osteomyelitis, left hand |
| M86349 | Chronic multifocal osteomyelitis, unspecified hand |
| M86351 | Chronic multifocal osteomyelitis, right femur |
| M86352 | Chronic multifocal osteomyelitis, left femur |
| M86359 | Chronic multifocal osteomyelitis, unspecified femur |
| M86361 | Chronic multifocal osteomyelitis, right tibia and fibula |
| M86362 | Chronic multifocal osteomyelitis, left tibia and fibula |
| M86369 | Chronic multifocal osteomyelitis, unspecified tibia and fibula |
| M86371 | Chronic multifocal osteomyelitis, right ankle and foot |
| M86372 | Chronic multifocal osteomyelitis, left ankle and foot |
| M86379 | Chronic multifocal osteomyelitis, unspecified ankle and foot |
| M8638 | Chronic multifocal osteomyelitis, other site |
| M8639 | Chronic multifocal osteomyelitis, multiple sites |
| M8640 | Chronic osteomyelitis with draining sinus, unspecified site |
| M86411 | Chronic osteomyelitis with draining sinus, right shoulder |
| M86412 | Chronic osteomyelitis with draining sinus, left shoulder |
| M86419 | Chronic osteomyelitis with draining sinus, unspecified shoulder |
| M86421 | Chronic osteomyelitis with draining sinus, right humerus |
| M86422 | Chronic osteomyelitis with draining sinus, left humerus |
| M86429 | Chronic osteomyelitis with draining sinus, unspecified humerus |
| M86431 | Chronic osteomyelitis with draining sinus, right radius and ulna |
| M86432 | Chronic osteomyelitis with draining sinus, left radius and ulna |
| M86439 | Chronic osteomyelitis with draining sinus, unspecified radius and ulna |
| M86441 | Chronic osteomyelitis with draining sinus, right hand |
| M86442 | Chronic osteomyelitis with draining sinus, left hand |
| M86449 | Chronic osteomyelitis with draining sinus, unspecified hand |
| M86451 | Chronic osteomyelitis with draining sinus, right femur |
| M86452 | Chronic osteomyelitis with draining sinus, left femur |
| M86459 | Chronic osteomyelitis with draining sinus, unspecified femur |
| M86461 | Chronic osteomyelitis with draining sinus, right tibia and fibula |
| M86462 | Chronic osteomyelitis with draining sinus, left tibia and fibula |
| M86469 | Chronic osteomyelitis with draining sinus, unspecified tibia and fibula |
| M86471 | Chronic osteomyelitis with draining sinus, right ankle and foot |
| M86472 | Chronic osteomyelitis with draining sinus, left ankle and foot |
| M86479 | Chronic osteomyelitis with draining sinus, unspecified ankle and foot |
| M8648 | Chronic osteomyelitis with draining sinus, other site |
| M8649 | Chronic osteomyelitis with draining sinus, multiple sites |
| M8650 | Other chronic hematogenous osteomyelitis, unspecified site |
| M86511 | Other chronic hematogenous osteomyelitis, right shoulder |
| M86512 | Other chronic hematogenous osteomyelitis, left shoulder |
| M86519 | Other chronic hematogenous osteomyelitis, unspecified shoulder |
| M86521 | Other chronic hematogenous osteomyelitis, right humerus |
| M86522 | Other chronic hematogenous osteomyelitis, left humerus |
| M86529 | Other chronic hematogenous osteomyelitis, unspecified humerus |
| M86531 | Other chronic hematogenous osteomyelitis, right radius and ulna |
| M86532 | Other chronic hematogenous osteomyelitis, left radius and ulna |
| M86539 | Other chronic hematogenous osteomyelitis, unspecified radius and ulna |
| M86541 | Other chronic hematogenous osteomyelitis, right hand |
| M86542 | Other chronic hematogenous osteomyelitis, left hand |
| M86549 | Other chronic hematogenous osteomyelitis, unspecified hand |
| M86551 | Other chronic hematogenous osteomyelitis, right femur |
| M86552 | Other chronic hematogenous osteomyelitis, left femur |
| M86559 | Other chronic hematogenous osteomyelitis, unspecified femur |
| M86561 | Other chronic hematogenous osteomyelitis, right tibia and fibula |
| M86562 | Other chronic hematogenous osteomyelitis, left tibia and fibula |
| M86569 | Other chronic hematogenous osteomyelitis, unspecified tibia and fibula |
| M86571 | Other chronic hematogenous osteomyelitis, right ankle and foot |
| M86572 | Other chronic hematogenous osteomyelitis, left ankle and foot |
| M86579 | Other chronic hematogenous osteomyelitis, unspecified ankle and foot |
| M8658 | Other chronic hematogenous osteomyelitis, other site |
| M8659 | Other chronic hematogenous osteomyelitis, multiple sites |
| M8660 | Other chronic osteomyelitis, unspecified site |
| M86611 | Other chronic osteomyelitis, right shoulder |
| M86612 | Other chronic osteomyelitis, left shoulder |
| M86619 | Other chronic osteomyelitis, unspecified shoulder |
| M86621 | Other chronic osteomyelitis, right humerus |
| M86622 | Other chronic osteomyelitis, left humerus |
| M86629 | Other chronic osteomyelitis, unspecified humerus |
| M86631 | Other chronic osteomyelitis, right radius and ulna |
| M86632 | Other chronic osteomyelitis, left radius and ulna |
| M86639 | Other chronic osteomyelitis, unspecified radius and ulna |
| M86641 | Other chronic osteomyelitis, right hand |
| M86642 | Other chronic osteomyelitis, left hand |
| M86649 | Other chronic osteomyelitis, unspecified hand |
| M86651 | Other chronic osteomyelitis, right thigh |
| M86652 | Other chronic osteomyelitis, left thigh |
| M86659 | Other chronic osteomyelitis, unspecified thigh |
| M86661 | Other chronic osteomyelitis, right tibia and fibula |
| M86662 | Other chronic osteomyelitis, left tibia and fibula |
| M86669 | Other chronic osteomyelitis, unspecified tibia and fibula |
| M86671 | Other chronic osteomyelitis, right ankle and foot |
| M86672 | Other chronic osteomyelitis, left ankle and foot |
| M86679 | Other chronic osteomyelitis, unspecified ankle and foot |
| M8668 | Other chronic osteomyelitis, other site |
| M8669 | Other chronic osteomyelitis, multiple sites |
| M868X0 | Other osteomyelitis, multiple sites |
| M868X1 | Other osteomyelitis, shoulder |
| M868X2 | Other osteomyelitis, upper arm |
| M868X3 | Other osteomyelitis, forearm |
| M868X4 | Other osteomyelitis, hand |
| M868X5 | Other osteomyelitis, thigh |
| M868X6 | Other osteomyelitis, lower leg |
| M868X7 | Other osteomyelitis, ankle and foot |
| M868X8 | Other osteomyelitis, other site |
| M868X9 | Other osteomyelitis, unspecified sites |
| M869 | Osteomyelitis, unspecified |
| M8700 | Idiopathic aseptic necrosis of unspecified bone |
| M87011 | Idiopathic aseptic necrosis of right shoulder |
| M87012 | Idiopathic aseptic necrosis of left shoulder |
| M87019 | Idiopathic aseptic necrosis of unspecified shoulder |
| M87021 | Idiopathic aseptic necrosis of right humerus |
| M87022 | Idiopathic aseptic necrosis of left humerus |
| M87029 | Idiopathic aseptic necrosis of unspecified humerus |
| M87031 | Idiopathic aseptic necrosis of right radius |
| M87032 | Idiopathic aseptic necrosis of left radius |
| M87033 | Idiopathic aseptic necrosis of unspecified radius |
| M87034 | Idiopathic aseptic necrosis of right ulna |
| M87035 | Idiopathic aseptic necrosis of left ulna |
| M87036 | Idiopathic aseptic necrosis of unspecified ulna |
| M87037 | Idiopathic aseptic necrosis of right carpus |
| M87038 | Idiopathic aseptic necrosis of left carpus |
| M87039 | Idiopathic aseptic necrosis of unspecified carpus |
| M87041 | Idiopathic aseptic necrosis of right hand |
| M87042 | Idiopathic aseptic necrosis of left hand |
| M87043 | Idiopathic aseptic necrosis of unspecified hand |
| M87044 | Idiopathic aseptic necrosis of right finger(s) |
| M87045 | Idiopathic aseptic necrosis of left finger(s) |
| M87046 | Idiopathic aseptic necrosis of unspecified finger(s) |
| M87050 | Idiopathic aseptic necrosis of pelvis |
| M87051 | Idiopathic aseptic necrosis of right femur |
| M87052 | Idiopathic aseptic necrosis of left femur |
| M87059 | Idiopathic aseptic necrosis of unspecified femur |
| M87061 | Idiopathic aseptic necrosis of right tibia |
| M87062 | Idiopathic aseptic necrosis of left tibia |
| M87063 | Idiopathic aseptic necrosis of unspecified tibia |
| M87064 | Idiopathic aseptic necrosis of right fibula |
| M87065 | Idiopathic aseptic necrosis of left fibula |
| M87066 | Idiopathic aseptic necrosis of unspecified fibula |
| M87071 | Idiopathic aseptic necrosis of right ankle |
| M87072 | Idiopathic aseptic necrosis of left ankle |
| M87073 | Idiopathic aseptic necrosis of unspecified ankle |
| M87074 | Idiopathic aseptic necrosis of right foot |
| M87075 | Idiopathic aseptic necrosis of left foot |
| M87076 | Idiopathic aseptic necrosis of unspecified foot |
| M87077 | Idiopathic aseptic necrosis of right toe(s) |
| M87078 | Idiopathic aseptic necrosis of left toe(s) |
| M87079 | Idiopathic aseptic necrosis of unspecified toe(s) |
| M8708 | Idiopathic aseptic necrosis of bone, other site |
| M8709 | Idiopathic aseptic necrosis of bone, multiple sites |
| M8720 | Osteonecrosis due to previous trauma, unspecified bone |
| M87211 | Osteonecrosis due to previous trauma, right shoulder |
| M87212 | Osteonecrosis due to previous trauma, left shoulder |
| M87219 | Osteonecrosis due to previous trauma, unspecified shoulder |
| M87221 | Osteonecrosis due to previous trauma, right humerus |
| M87222 | Osteonecrosis due to previous trauma, left humerus |
| M87229 | Osteonecrosis due to previous trauma, unspecified humerus |
| M87231 | Osteonecrosis due to previous trauma of right radius |
| M87232 | Osteonecrosis due to previous trauma of left radius |
| M87233 | Osteonecrosis due to previous trauma of unspecified radius |
| M87234 | Osteonecrosis due to previous trauma of right ulna |
| M87235 | Osteonecrosis due to previous trauma of left ulna |
| M87236 | Osteonecrosis due to previous trauma of unspecified ulna |
| M87237 | Osteonecrosis due to previous trauma of right carpus |
| M87238 | Osteonecrosis due to previous trauma of left carpus |
| M87239 | Osteonecrosis due to previous trauma of unspecified carpus |
| M87241 | Osteonecrosis due to previous trauma, right hand |
| M87242 | Osteonecrosis due to previous trauma, left hand |
| M87243 | Osteonecrosis due to previous trauma, unspecified hand |
| M87244 | Osteonecrosis due to previous trauma, right finger(s) |
| M87245 | Osteonecrosis due to previous trauma, left finger(s) |
| M87246 | Osteonecrosis due to previous trauma, unspecified finger(s) |
| M87250 | Osteonecrosis due to previous trauma, pelvis |
| M87251 | Osteonecrosis due to previous trauma, right femur |
| M87252 | Osteonecrosis due to previous trauma, left femur |
| M87256 | Osteonecrosis due to previous trauma, unspecified femur |
| M87261 | Osteonecrosis due to previous trauma, right tibia |
| M87262 | Osteonecrosis due to previous trauma, left tibia |
| M87263 | Osteonecrosis due to previous trauma, unspecified tibia |
| M87264 | Osteonecrosis due to previous trauma, right fibula |
| M87265 | Osteonecrosis due to previous trauma, left fibula |
| M87266 | Osteonecrosis due to previous trauma, unspecified fibula |
| M87271 | Osteonecrosis due to previous trauma, right ankle |
| M87272 | Osteonecrosis due to previous trauma, left ankle |
| M87273 | Osteonecrosis due to previous trauma, unspecified ankle |
| M87274 | Osteonecrosis due to previous trauma, right foot |
| M87275 | Osteonecrosis due to previous trauma, left foot |
| M87276 | Osteonecrosis due to previous trauma, unspecified foot |
| M87277 | Osteonecrosis due to previous trauma, right toe(s) |
| M87278 | Osteonecrosis due to previous trauma, left toe(s) |
| M87279 | Osteonecrosis due to previous trauma, unspecified toe(s) |
| M8728 | Osteonecrosis due to previous trauma, other site |
| M8729 | Osteonecrosis due to previous trauma, multiple sites |
| M8730 | Other secondary osteonecrosis, unspecified bone |
| M87311 | Other secondary osteonecrosis, right shoulder |
| M87312 | Other secondary osteonecrosis, left shoulder |
| M87319 | Other secondary osteonecrosis, unspecified shoulder |
| M87321 | Other secondary osteonecrosis, right humerus |
| M87322 | Other secondary osteonecrosis, left humerus |
| M87329 | Other secondary osteonecrosis, unspecified humerus |
| M87331 | Other secondary osteonecrosis of right radius |
| M87332 | Other secondary osteonecrosis of left radius |
| M87333 | Other secondary osteonecrosis of unspecified radius |
| M87334 | Other secondary osteonecrosis of right ulna |
| M87335 | Other secondary osteonecrosis of left ulna |
| M87336 | Other secondary osteonecrosis of unspecified ulna |
| M87337 | Other secondary osteonecrosis of right carpus |
| M87338 | Other secondary osteonecrosis of left carpus |
| M87339 | Other secondary osteonecrosis of unspecified carpus |
| M87341 | Other secondary osteonecrosis, right hand |
| M87342 | Other secondary osteonecrosis, left hand |
| M87343 | Other secondary osteonecrosis, unspecified hand |
| M87344 | Other secondary osteonecrosis, right finger(s) |
| M87345 | Other secondary osteonecrosis, left finger(s) |
| M87346 | Other secondary osteonecrosis, unspecified finger(s) |
| M87350 | Other secondary osteonecrosis, pelvis |
| M87351 | Other secondary osteonecrosis, right femur |
| M87352 | Other secondary osteonecrosis, left femur |
| M87353 | Other secondary osteonecrosis, unspecified femur |
| M87361 | Other secondary osteonecrosis, right tibia |
| M87362 | Other secondary osteonecrosis, left tibia |
| M87363 | Other secondary osteonecrosis, unspecified tibia |
| M87364 | Other secondary osteonecrosis, right fibula |
| M87365 | Other secondary osteonecrosis, left fibula |
| M87366 | Other secondary osteonecrosis, unspecified fibula |
| M87371 | Other secondary osteonecrosis, right ankle |
| M87372 | Other secondary osteonecrosis, left ankle |
| M87373 | Other secondary osteonecrosis, unspecified ankle |
| M87374 | Other secondary osteonecrosis, right foot |
| M87375 | Other secondary osteonecrosis, left foot |
| M87376 | Other secondary osteonecrosis, unspecified foot |
| M87377 | Other secondary osteonecrosis, right toe(s) |
| M87378 | Other secondary osteonecrosis, left toe(s) |
| M87379 | Other secondary osteonecrosis, unspecified toe(s) |
| M8738 | Other secondary osteonecrosis, other site |
| M8739 | Other secondary osteonecrosis, multiple sites |
| M8780 | Other osteonecrosis, unspecified bone |
| M87811 | Other osteonecrosis, right shoulder |
| M87812 | Other osteonecrosis, left shoulder |
| M87819 | Other osteonecrosis, unspecified shoulder |
| M87821 | Other osteonecrosis, right humerus |
| M87822 | Other osteonecrosis, left humerus |
| M87829 | Other osteonecrosis, unspecified humerus |
| M87831 | Other osteonecrosis of right radius |
| M87832 | Other osteonecrosis of left radius |
| M87833 | Other osteonecrosis of unspecified radius |
| M87834 | Other osteonecrosis of right ulna |
| M87835 | Other osteonecrosis of left ulna |
| M87836 | Other osteonecrosis of unspecified ulna |
| M87837 | Other osteonecrosis of right carpus |
| M87838 | Other osteonecrosis of left carpus |
| M87839 | Other osteonecrosis of unspecified carpus |
| M87841 | Other osteonecrosis, right hand |
| M87842 | Other osteonecrosis, left hand |
| M87843 | Other osteonecrosis, unspecified hand |
| M87844 | Other osteonecrosis, right finger(s) |
| M87845 | Other osteonecrosis, left finger(s) |
| M87849 | Other osteonecrosis, unspecified finger(s) |
| M87850 | Other osteonecrosis, pelvis |
| M87851 | Other osteonecrosis, right femur |
| M87852 | Other osteonecrosis, left femur |
| M87859 | Other osteonecrosis, unspecified femur |
| M87861 | Other osteonecrosis, right tibia |
| M87862 | Other osteonecrosis, left tibia |
| M87863 | Other osteonecrosis, unspecified tibia |
| M87864 | Other osteonecrosis, right fibula |
| M87865 | Other osteonecrosis, left fibula |
| M87869 | Other osteonecrosis, unspecified fibula |
| M87871 | Other osteonecrosis, right ankle |
| M87872 | Other osteonecrosis, left ankle |
| M87873 | Other osteonecrosis, unspecified ankle |
| M87874 | Other osteonecrosis, right foot |
| M87875 | Other osteonecrosis, left foot |
| M87876 | Other osteonecrosis, unspecified foot |
| M87877 | Other osteonecrosis, right toe(s) |
| M87878 | Other osteonecrosis, left toe(s) |
| M87879 | Other osteonecrosis, unspecified toe(s) |
| M8788 | Other osteonecrosis, other site |
| M8789 | Other osteonecrosis, multiple sites |
| M879 | Osteonecrosis, unspecified |
| M8960 | Osteopathy after poliomyelitis, unspecified site |
| M89611 | Osteopathy after poliomyelitis, right shoulder |
| M89612 | Osteopathy after poliomyelitis, left shoulder |
| M89619 | Osteopathy after poliomyelitis, unspecified shoulder |
| M89621 | Osteopathy after poliomyelitis, right upper arm |
| M89622 | Osteopathy after poliomyelitis, left upper arm |
| M89629 | Osteopathy after poliomyelitis, unspecified upper arm |
| M89631 | Osteopathy after poliomyelitis, right forearm |
| M89632 | Osteopathy after poliomyelitis, left forearm |
| M89639 | Osteopathy after poliomyelitis, unspecified forearm |
| M89641 | Osteopathy after poliomyelitis, right hand |
| M89642 | Osteopathy after poliomyelitis, left hand |
| M89649 | Osteopathy after poliomyelitis, unspecified hand |
| M89651 | Osteopathy after poliomyelitis, right thigh |
| M89652 | Osteopathy after poliomyelitis, left thigh |
| M89659 | Osteopathy after poliomyelitis, unspecified thigh |
| M89661 | Osteopathy after poliomyelitis, right lower leg |
| M89662 | Osteopathy after poliomyelitis, left lower leg |
| M89669 | Osteopathy after poliomyelitis, unspecified lower leg |
| M89671 | Osteopathy after poliomyelitis, right ankle and foot |
| M89672 | Osteopathy after poliomyelitis, left ankle and foot |
| M89679 | Osteopathy after poliomyelitis, unspecified ankle and foot |
| M8968 | Osteopathy after poliomyelitis, other site |
| M8969 | Osteopathy after poliomyelitis, multiple sites |
| M9050 | Osteonecrosis in diseases classified elsewhere, unspecified site |
| M90511 | Osteonecrosis in diseases classified elsewhere, right shoulder |
| M90512 | Osteonecrosis in diseases classified elsewhere, left shoulder |
| M90519 | Osteonecrosis in diseases classified elsewhere, unspecified shoulder |
| M90521 | Osteonecrosis in diseases classified elsewhere, right upper arm |
| M90522 | Osteonecrosis in diseases classified elsewhere, left upper arm |
| M90529 | Osteonecrosis in diseases classified elsewhere, unspecified upper arm |
| M90531 | Osteonecrosis in diseases classified elsewhere, right forearm |
| M90532 | Osteonecrosis in diseases classified elsewhere, left forearm |
| M90539 | Osteonecrosis in diseases classified elsewhere, unspecified forearm |
| M90541 | Osteonecrosis in diseases classified elsewhere, right hand |
| M90542 | Osteonecrosis in diseases classified elsewhere, left hand |
| M90549 | Osteonecrosis in diseases classified elsewhere, unspecified hand |
| M90551 | Osteonecrosis in diseases classified elsewhere, right thigh |
| M90552 | Osteonecrosis in diseases classified elsewhere, left thigh |
| M90559 | Osteonecrosis in diseases classified elsewhere, unspecified thigh |
| M90561 | Osteonecrosis in diseases classified elsewhere, right lower leg |
| M90562 | Osteonecrosis in diseases classified elsewhere, left lower leg |
| M90569 | Osteonecrosis in diseases classified elsewhere, unspecified lower leg |
| M90571 | Osteonecrosis in diseases classified elsewhere, right ankle and foot |
| M90572 | Osteonecrosis in diseases classified elsewhere, left ankle and foot |
| M90579 | Osteonecrosis in diseases classified elsewhere, unspecified ankle and foot |
| M9058 | Osteonecrosis in diseases classified elsewhere, other site |
| M9059 | Osteonecrosis in diseases classified elsewhere, multiple sites |
| N493 | Fournier gangrene |
| N7682 | Fournier disease of vagina and vulva |
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 |
|---|---|
| 39 | 608 |
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 92?
609 ICD-10-CM codes map to HCC 92 in the CMS PY2027 initial mapping, for example A0104 Typhoid arthritis; A0105 Typhoid osteomyelitis; A0223 Salmonella arthritis; A0224 Salmonella osteomyelitis. 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 92 add to a risk score?
The V28 relative factor for HCC 92 is 0.479 for a community, non-dual, aged beneficiary, 0.611 for full-benefit dual aged, 0.529 for non-dual disabled and 0.556 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 92 count together with related categories?
HCC 92 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 92 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.