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_HCC93 | 0.617 |
| Community, non-dual, disabled | CND_HCC93 | 0.470 |
| Community, full-benefit dual, aged | CFA_HCC93 | 0.439 |
| Community, full-benefit dual, disabled | CFD_HCC93 | 0.384 |
| Community, partial-benefit dual, aged | CPA_HCC93 | 0.405 |
| Community, partial-benefit dual, disabled | CPD_HCC93 | 0.288 |
| Long-term institutional | INS_HCC93 | 0.297 |
Hierarchy
Hierarchical condition categories pay only the most severe manifestation of a disease. HCC 93 is the most severe category in its hierarchy. When HCC 93 is present it drops HCC 94 (Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders), 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 93
508 codes map to this category in the PY2027 initial mapping, concentrated in the M05 (211), M08 (125), M06 (100), M45 (20), M33 (19), M48 (9) 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 |
|---|---|
| D8686 | Sarcoid arthropathy |
| D8687 | Sarcoid myositis |
| G7241 | Inclusion body myositis [IBM] |
| I7782 | Antineutrophilic cytoplasmic antibody [ANCA] vasculitis |
| L4050 | Arthropathic psoriasis, unspecified |
| L4051 | Distal interphalangeal psoriatic arthropathy |
| L4052 | Psoriatic arthritis mutilans |
| L4053 | Psoriatic spondylitis |
| L4054 | Psoriatic juvenile arthropathy |
| L4059 | Other psoriatic arthropathy |
| M0500 | Felty's syndrome, unspecified site |
| M05011 | Felty's syndrome, right shoulder |
| M05012 | Felty's syndrome, left shoulder |
| M05019 | Felty's syndrome, unspecified shoulder |
| M05021 | Felty's syndrome, right elbow |
| M05022 | Felty's syndrome, left elbow |
| M05029 | Felty's syndrome, unspecified elbow |
| M05031 | Felty's syndrome, right wrist |
| M05032 | Felty's syndrome, left wrist |
| M05039 | Felty's syndrome, unspecified wrist |
| M05041 | Felty's syndrome, right hand |
| M05042 | Felty's syndrome, left hand |
| M05049 | Felty's syndrome, unspecified hand |
| M05051 | Felty's syndrome, right hip |
| M05052 | Felty's syndrome, left hip |
| M05059 | Felty's syndrome, unspecified hip |
| M05061 | Felty's syndrome, right knee |
| M05062 | Felty's syndrome, left knee |
| M05069 | Felty's syndrome, unspecified knee |
| M05071 | Felty's syndrome, right ankle and foot |
| M05072 | Felty's syndrome, left ankle and foot |
| M05079 | Felty's syndrome, unspecified ankle and foot |
| M0509 | Felty's syndrome, multiple sites |
| M0510 | Rheumatoid lung disease with rheumatoid arthritis of unspecified site |
| M05111 | Rheumatoid lung disease with rheumatoid arthritis of right shoulder |
| M05112 | Rheumatoid lung disease with rheumatoid arthritis of left shoulder |
| M05119 | Rheumatoid lung disease with rheumatoid arthritis of unspecified shoulder |
| M05121 | Rheumatoid lung disease with rheumatoid arthritis of right elbow |
| M05122 | Rheumatoid lung disease with rheumatoid arthritis of left elbow |
| M05129 | Rheumatoid lung disease with rheumatoid arthritis of unspecified elbow |
| M05131 | Rheumatoid lung disease with rheumatoid arthritis of right wrist |
| M05132 | Rheumatoid lung disease with rheumatoid arthritis of left wrist |
| M05139 | Rheumatoid lung disease with rheumatoid arthritis of unspecified wrist |
| M05141 | Rheumatoid lung disease with rheumatoid arthritis of right hand |
| M05142 | Rheumatoid lung disease with rheumatoid arthritis of left hand |
| M05149 | Rheumatoid lung disease with rheumatoid arthritis of unspecified hand |
| M05151 | Rheumatoid lung disease with rheumatoid arthritis of right hip |
| M05152 | Rheumatoid lung disease with rheumatoid arthritis of left hip |
| M05159 | Rheumatoid lung disease with rheumatoid arthritis of unspecified hip |
| M05161 | Rheumatoid lung disease with rheumatoid arthritis of right knee |
| M05162 | Rheumatoid lung disease with rheumatoid arthritis of left knee |
| M05169 | Rheumatoid lung disease with rheumatoid arthritis of unspecified knee |
| M05171 | Rheumatoid lung disease with rheumatoid arthritis of right ankle and foot |
| M05172 | Rheumatoid lung disease with rheumatoid arthritis of left ankle and foot |
| M05179 | Rheumatoid lung disease with rheumatoid arthritis of unspecified ankle and foot |
| M0519 | Rheumatoid lung disease with rheumatoid arthritis of multiple sites |
| M0520 | Rheumatoid vasculitis with rheumatoid arthritis of unspecified site |
| M05211 | Rheumatoid vasculitis with rheumatoid arthritis of right shoulder |
| M05212 | Rheumatoid vasculitis with rheumatoid arthritis of left shoulder |
| M05219 | Rheumatoid vasculitis with rheumatoid arthritis of unspecified shoulder |
| M05221 | Rheumatoid vasculitis with rheumatoid arthritis of right elbow |
| M05222 | Rheumatoid vasculitis with rheumatoid arthritis of left elbow |
| M05229 | Rheumatoid vasculitis with rheumatoid arthritis of unspecified elbow |
| M05231 | Rheumatoid vasculitis with rheumatoid arthritis of right wrist |
| M05232 | Rheumatoid vasculitis with rheumatoid arthritis of left wrist |
| M05239 | Rheumatoid vasculitis with rheumatoid arthritis of unspecified wrist |
| M05241 | Rheumatoid vasculitis with rheumatoid arthritis of right hand |
| M05242 | Rheumatoid vasculitis with rheumatoid arthritis of left hand |
| M05249 | Rheumatoid vasculitis with rheumatoid arthritis of unspecified hand |
| M05251 | Rheumatoid vasculitis with rheumatoid arthritis of right hip |
| M05252 | Rheumatoid vasculitis with rheumatoid arthritis of left hip |
| M05259 | Rheumatoid vasculitis with rheumatoid arthritis of unspecified hip |
| M05261 | Rheumatoid vasculitis with rheumatoid arthritis of right knee |
| M05262 | Rheumatoid vasculitis with rheumatoid arthritis of left knee |
| M05269 | Rheumatoid vasculitis with rheumatoid arthritis of unspecified knee |
| M05271 | Rheumatoid vasculitis with rheumatoid arthritis of right ankle and foot |
| M05272 | Rheumatoid vasculitis with rheumatoid arthritis of left ankle and foot |
| M05279 | Rheumatoid vasculitis with rheumatoid arthritis of unspecified ankle and foot |
| M0529 | Rheumatoid vasculitis with rheumatoid arthritis of multiple sites |
| M0530 | Rheumatoid heart disease with rheumatoid arthritis of unspecified site |
| M05311 | Rheumatoid heart disease with rheumatoid arthritis of right shoulder |
| M05312 | Rheumatoid heart disease with rheumatoid arthritis of left shoulder |
| M05319 | Rheumatoid heart disease with rheumatoid arthritis of unspecified shoulder |
| M05321 | Rheumatoid heart disease with rheumatoid arthritis of right elbow |
| M05322 | Rheumatoid heart disease with rheumatoid arthritis of left elbow |
| M05329 | Rheumatoid heart disease with rheumatoid arthritis of unspecified elbow |
| M05331 | Rheumatoid heart disease with rheumatoid arthritis of right wrist |
| M05332 | Rheumatoid heart disease with rheumatoid arthritis of left wrist |
| M05339 | Rheumatoid heart disease with rheumatoid arthritis of unspecified wrist |
| M05341 | Rheumatoid heart disease with rheumatoid arthritis of right hand |
| M05342 | Rheumatoid heart disease with rheumatoid arthritis of left hand |
| M05349 | Rheumatoid heart disease with rheumatoid arthritis of unspecified hand |
| M05351 | Rheumatoid heart disease with rheumatoid arthritis of right hip |
| M05352 | Rheumatoid heart disease with rheumatoid arthritis of left hip |
| M05359 | Rheumatoid heart disease with rheumatoid arthritis of unspecified hip |
| M05361 | Rheumatoid heart disease with rheumatoid arthritis of right knee |
| M05362 | Rheumatoid heart disease with rheumatoid arthritis of left knee |
| M05369 | Rheumatoid heart disease with rheumatoid arthritis of unspecified knee |
| M05371 | Rheumatoid heart disease with rheumatoid arthritis of right ankle and foot |
| M05372 | Rheumatoid heart disease with rheumatoid arthritis of left ankle and foot |
| M05379 | Rheumatoid heart disease with rheumatoid arthritis of unspecified ankle and foot |
| M0539 | Rheumatoid heart disease with rheumatoid arthritis of multiple sites |
| M0540 | Rheumatoid myopathy with rheumatoid arthritis of unspecified site |
| M05411 | Rheumatoid myopathy with rheumatoid arthritis of right shoulder |
| M05412 | Rheumatoid myopathy with rheumatoid arthritis of left shoulder |
| M05419 | Rheumatoid myopathy with rheumatoid arthritis of unspecified shoulder |
| M05421 | Rheumatoid myopathy with rheumatoid arthritis of right elbow |
| M05422 | Rheumatoid myopathy with rheumatoid arthritis of left elbow |
| M05429 | Rheumatoid myopathy with rheumatoid arthritis of unspecified elbow |
| M05431 | Rheumatoid myopathy with rheumatoid arthritis of right wrist |
| M05432 | Rheumatoid myopathy with rheumatoid arthritis of left wrist |
| M05439 | Rheumatoid myopathy with rheumatoid arthritis of unspecified wrist |
| M05441 | Rheumatoid myopathy with rheumatoid arthritis of right hand |
| M05442 | Rheumatoid myopathy with rheumatoid arthritis of left hand |
| M05449 | Rheumatoid myopathy with rheumatoid arthritis of unspecified hand |
| M05451 | Rheumatoid myopathy with rheumatoid arthritis of right hip |
| M05452 | Rheumatoid myopathy with rheumatoid arthritis of left hip |
| M05459 | Rheumatoid myopathy with rheumatoid arthritis of unspecified hip |
| M05461 | Rheumatoid myopathy with rheumatoid arthritis of right knee |
| M05462 | Rheumatoid myopathy with rheumatoid arthritis of left knee |
| M05469 | Rheumatoid myopathy with rheumatoid arthritis of unspecified knee |
| M05471 | Rheumatoid myopathy with rheumatoid arthritis of right ankle and foot |
| M05472 | Rheumatoid myopathy with rheumatoid arthritis of left ankle and foot |
| M05479 | Rheumatoid myopathy with rheumatoid arthritis of unspecified ankle and foot |
| M0549 | Rheumatoid myopathy with rheumatoid arthritis of multiple sites |
| M0550 | Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site |
| M05511 | Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder |
| M05512 | Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder |
| M05519 | Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified shoulder |
| M05521 | Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow |
| M05522 | Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow |
| M05529 | Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified elbow |
| M05531 | Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist |
| M05532 | Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist |
| M05539 | Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified wrist |
| M05541 | Rheumatoid polyneuropathy with rheumatoid arthritis of right hand |
| M05542 | Rheumatoid polyneuropathy with rheumatoid arthritis of left hand |
| M05549 | Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hand |
| M05551 | Rheumatoid polyneuropathy with rheumatoid arthritis of right hip |
| M05552 | Rheumatoid polyneuropathy with rheumatoid arthritis of left hip |
| M05559 | Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hip |
| M05561 | Rheumatoid polyneuropathy with rheumatoid arthritis of right knee |
| M05562 | Rheumatoid polyneuropathy with rheumatoid arthritis of left knee |
| M05569 | Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee |
| M05571 | Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot |
| M05572 | Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot |
| M05579 | Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified ankle and foot |
| M0559 | Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites |
| M0560 | Rheumatoid arthritis of unspecified site with involvement of other organs and systems |
| M05611 | Rheumatoid arthritis of right shoulder with involvement of other organs and systems |
| M05612 | Rheumatoid arthritis of left shoulder with involvement of other organs and systems |
| M05619 | Rheumatoid arthritis of unspecified shoulder with involvement of other organs and systems |
| M05621 | Rheumatoid arthritis of right elbow with involvement of other organs and systems |
| M05622 | Rheumatoid arthritis of left elbow with involvement of other organs and systems |
| M05629 | Rheumatoid arthritis of unspecified elbow with involvement of other organs and systems |
| M05631 | Rheumatoid arthritis of right wrist with involvement of other organs and systems |
| M05632 | Rheumatoid arthritis of left wrist with involvement of other organs and systems |
| M05639 | Rheumatoid arthritis of unspecified wrist with involvement of other organs and systems |
| M05641 | Rheumatoid arthritis of right hand with involvement of other organs and systems |
| M05642 | Rheumatoid arthritis of left hand with involvement of other organs and systems |
| M05649 | Rheumatoid arthritis of unspecified hand with involvement of other organs and systems |
| M05651 | Rheumatoid arthritis of right hip with involvement of other organs and systems |
| M05652 | Rheumatoid arthritis of left hip with involvement of other organs and systems |
| M05659 | Rheumatoid arthritis of unspecified hip with involvement of other organs and systems |
| M05661 | Rheumatoid arthritis of right knee with involvement of other organs and systems |
| M05662 | Rheumatoid arthritis of left knee with involvement of other organs and systems |
| M05669 | Rheumatoid arthritis of unspecified knee with involvement of other organs and systems |
| M05671 | Rheumatoid arthritis of right ankle and foot with involvement of other organs and systems |
| M05672 | Rheumatoid arthritis of left ankle and foot with involvement of other organs and systems |
| M05679 | Rheumatoid arthritis of unspecified ankle and foot with involvement of other organs and systems |
| M0569 | Rheumatoid arthritis of multiple sites with involvement of other organs and systems |
| M0570 | Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement |
| M05711 | Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement |
| M05712 | Rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement |
| M05719 | Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement |
| M05721 | Rheumatoid arthritis with rheumatoid factor of right elbow without organ or systems involvement |
| M05722 | Rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement |
| M05729 | Rheumatoid arthritis with rheumatoid factor of unspecified elbow without organ or systems involvement |
| M05731 | Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement |
| M05732 | Rheumatoid arthritis with rheumatoid factor of left wrist without organ or systems involvement |
| M05739 | Rheumatoid arthritis with rheumatoid factor of unspecified wrist without organ or systems involvement |
| M05741 | Rheumatoid arthritis with rheumatoid factor of right hand without organ or systems involvement |
| M05742 | Rheumatoid arthritis with rheumatoid factor of left hand without organ or systems involvement |
| M05749 | Rheumatoid arthritis with rheumatoid factor of unspecified hand without organ or systems involvement |
| M05751 | Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement |
| M05752 | Rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement |
| M05759 | Rheumatoid arthritis with rheumatoid factor of unspecified hip without organ or systems involvement |
| M05761 | Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement |
| M05762 | Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement |
| M05769 | Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement |
| M05771 | Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement |
| M05772 | Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement |
| M05779 | Rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot without organ or systems involvement |
| M0579 | Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement |
| M057A | Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvement |
| M0580 | Other rheumatoid arthritis with rheumatoid factor of unspecified site |
| M05811 | Other rheumatoid arthritis with rheumatoid factor of right shoulder |
| M05812 | Other rheumatoid arthritis with rheumatoid factor of left shoulder |
| M05819 | Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder |
| M05821 | Other rheumatoid arthritis with rheumatoid factor of right elbow |
| M05822 | Other rheumatoid arthritis with rheumatoid factor of left elbow |
| M05829 | Other rheumatoid arthritis with rheumatoid factor of unspecified elbow |
| M05831 | Other rheumatoid arthritis with rheumatoid factor of right wrist |
| M05832 | Other rheumatoid arthritis with rheumatoid factor of left wrist |
| M05839 | Other rheumatoid arthritis with rheumatoid factor of unspecified wrist |
| M05841 | Other rheumatoid arthritis with rheumatoid factor of right hand |
| M05842 | Other rheumatoid arthritis with rheumatoid factor of left hand |
| M05849 | Other rheumatoid arthritis with rheumatoid factor of unspecified hand |
| M05851 | Other rheumatoid arthritis with rheumatoid factor of right hip |
| M05852 | Other rheumatoid arthritis with rheumatoid factor of left hip |
| M05859 | Other rheumatoid arthritis with rheumatoid factor of unspecified hip |
| M05861 | Other rheumatoid arthritis with rheumatoid factor of right knee |
| M05862 | Other rheumatoid arthritis with rheumatoid factor of left knee |
| M05869 | Other rheumatoid arthritis with rheumatoid factor of unspecified knee |
| M05871 | Other rheumatoid arthritis with rheumatoid factor of right ankle and foot |
| M05872 | Other rheumatoid arthritis with rheumatoid factor of left ankle and foot |
| M05879 | Other rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot |
| M0589 | Other rheumatoid arthritis with rheumatoid factor of multiple sites |
| M058A | Other rheumatoid arthritis with rheumatoid factor of other specified site |
| M059 | Rheumatoid arthritis with rheumatoid factor, unspecified |
| M05A | Abnormal rheumatoid factor and anti-citrullinated protein antibody with rheumatoid arthritis |
| M0600 | Rheumatoid arthritis without rheumatoid factor, unspecified site |
| M06011 | Rheumatoid arthritis without rheumatoid factor, right shoulder |
| M06012 | Rheumatoid arthritis without rheumatoid factor, left shoulder |
| M06019 | Rheumatoid arthritis without rheumatoid factor, unspecified shoulder |
| M06021 | Rheumatoid arthritis without rheumatoid factor, right elbow |
| M06022 | Rheumatoid arthritis without rheumatoid factor, left elbow |
| M06029 | Rheumatoid arthritis without rheumatoid factor, unspecified elbow |
| M06031 | Rheumatoid arthritis without rheumatoid factor, right wrist |
| M06032 | Rheumatoid arthritis without rheumatoid factor, left wrist |
| M06039 | Rheumatoid arthritis without rheumatoid factor, unspecified wrist |
| M06041 | Rheumatoid arthritis without rheumatoid factor, right hand |
| M06042 | Rheumatoid arthritis without rheumatoid factor, left hand |
| M06049 | Rheumatoid arthritis without rheumatoid factor, unspecified hand |
| M06051 | Rheumatoid arthritis without rheumatoid factor, right hip |
| M06052 | Rheumatoid arthritis without rheumatoid factor, left hip |
| M06059 | Rheumatoid arthritis without rheumatoid factor, unspecified hip |
| M06061 | Rheumatoid arthritis without rheumatoid factor, right knee |
| M06062 | Rheumatoid arthritis without rheumatoid factor, left knee |
| M06069 | Rheumatoid arthritis without rheumatoid factor, unspecified knee |
| M06071 | Rheumatoid arthritis without rheumatoid factor, right ankle and foot |
| M06072 | Rheumatoid arthritis without rheumatoid factor, left ankle and foot |
| M06079 | Rheumatoid arthritis without rheumatoid factor, unspecified ankle and foot |
| M0608 | Rheumatoid arthritis without rheumatoid factor, vertebrae |
| M0609 | Rheumatoid arthritis without rheumatoid factor, multiple sites |
| M060A | Rheumatoid arthritis without rheumatoid factor, other specified site |
| M061 | Adult-onset Still's disease |
| M0620 | Rheumatoid bursitis, unspecified site |
| M06211 | Rheumatoid bursitis, right shoulder |
| M06212 | Rheumatoid bursitis, left shoulder |
| M06219 | Rheumatoid bursitis, unspecified shoulder |
| M06221 | Rheumatoid bursitis, right elbow |
| M06222 | Rheumatoid bursitis, left elbow |
| M06229 | Rheumatoid bursitis, unspecified elbow |
| M06231 | Rheumatoid bursitis, right wrist |
| M06232 | Rheumatoid bursitis, left wrist |
| M06239 | Rheumatoid bursitis, unspecified wrist |
| M06241 | Rheumatoid bursitis, right hand |
| M06242 | Rheumatoid bursitis, left hand |
| M06249 | Rheumatoid bursitis, unspecified hand |
| M06251 | Rheumatoid bursitis, right hip |
| M06252 | Rheumatoid bursitis, left hip |
| M06259 | Rheumatoid bursitis, unspecified hip |
| M06261 | Rheumatoid bursitis, right knee |
| M06262 | Rheumatoid bursitis, left knee |
| M06269 | Rheumatoid bursitis, unspecified knee |
| M06271 | Rheumatoid bursitis, right ankle and foot |
| M06272 | Rheumatoid bursitis, left ankle and foot |
| M06279 | Rheumatoid bursitis, unspecified ankle and foot |
| M0628 | Rheumatoid bursitis, vertebrae |
| M0629 | Rheumatoid bursitis, multiple sites |
| M0630 | Rheumatoid nodule, unspecified site |
| M06311 | Rheumatoid nodule, right shoulder |
| M06312 | Rheumatoid nodule, left shoulder |
| M06319 | Rheumatoid nodule, unspecified shoulder |
| M06321 | Rheumatoid nodule, right elbow |
| M06322 | Rheumatoid nodule, left elbow |
| M06329 | Rheumatoid nodule, unspecified elbow |
| M06331 | Rheumatoid nodule, right wrist |
| M06332 | Rheumatoid nodule, left wrist |
| M06339 | Rheumatoid nodule, unspecified wrist |
| M06341 | Rheumatoid nodule, right hand |
| M06342 | Rheumatoid nodule, left hand |
| M06349 | Rheumatoid nodule, unspecified hand |
| M06351 | Rheumatoid nodule, right hip |
| M06352 | Rheumatoid nodule, left hip |
| M06359 | Rheumatoid nodule, unspecified hip |
| M06361 | Rheumatoid nodule, right knee |
| M06362 | Rheumatoid nodule, left knee |
| M06369 | Rheumatoid nodule, unspecified knee |
| M06371 | Rheumatoid nodule, right ankle and foot |
| M06372 | Rheumatoid nodule, left ankle and foot |
| M06379 | Rheumatoid nodule, unspecified ankle and foot |
| M0638 | Rheumatoid nodule, vertebrae |
| M0639 | Rheumatoid nodule, multiple sites |
| M0680 | Other specified rheumatoid arthritis, unspecified site |
| M06811 | Other specified rheumatoid arthritis, right shoulder |
| M06812 | Other specified rheumatoid arthritis, left shoulder |
| M06819 | Other specified rheumatoid arthritis, unspecified shoulder |
| M06821 | Other specified rheumatoid arthritis, right elbow |
| M06822 | Other specified rheumatoid arthritis, left elbow |
| M06829 | Other specified rheumatoid arthritis, unspecified elbow |
| M06831 | Other specified rheumatoid arthritis, right wrist |
| M06832 | Other specified rheumatoid arthritis, left wrist |
| M06839 | Other specified rheumatoid arthritis, unspecified wrist |
| M06841 | Other specified rheumatoid arthritis, right hand |
| M06842 | Other specified rheumatoid arthritis, left hand |
| M06849 | Other specified rheumatoid arthritis, unspecified hand |
| M06851 | Other specified rheumatoid arthritis, right hip |
| M06852 | Other specified rheumatoid arthritis, left hip |
| M06859 | Other specified rheumatoid arthritis, unspecified hip |
| M06861 | Other specified rheumatoid arthritis, right knee |
| M06862 | Other specified rheumatoid arthritis, left knee |
| M06869 | Other specified rheumatoid arthritis, unspecified knee |
| M06871 | Other specified rheumatoid arthritis, right ankle and foot |
| M06872 | Other specified rheumatoid arthritis, left ankle and foot |
| M06879 | Other specified rheumatoid arthritis, unspecified ankle and foot |
| M0688 | Other specified rheumatoid arthritis, vertebrae |
| M0689 | Other specified rheumatoid arthritis, multiple sites |
| M068A | Other specified rheumatoid arthritis, other specified site |
| M069 | Rheumatoid arthritis, unspecified |
| M0800 | Unspecified juvenile rheumatoid arthritis of unspecified site |
| M08011 | Unspecified juvenile rheumatoid arthritis, right shoulder |
| M08012 | Unspecified juvenile rheumatoid arthritis, left shoulder |
| M08019 | Unspecified juvenile rheumatoid arthritis, unspecified shoulder |
| M08021 | Unspecified juvenile rheumatoid arthritis, right elbow |
| M08022 | Unspecified juvenile rheumatoid arthritis, left elbow |
| M08029 | Unspecified juvenile rheumatoid arthritis, unspecified elbow |
| M08031 | Unspecified juvenile rheumatoid arthritis, right wrist |
| M08032 | Unspecified juvenile rheumatoid arthritis, left wrist |
| M08039 | Unspecified juvenile rheumatoid arthritis, unspecified wrist |
| M08041 | Unspecified juvenile rheumatoid arthritis, right hand |
| M08042 | Unspecified juvenile rheumatoid arthritis, left hand |
| M08049 | Unspecified juvenile rheumatoid arthritis, unspecified hand |
| M08051 | Unspecified juvenile rheumatoid arthritis, right hip |
| M08052 | Unspecified juvenile rheumatoid arthritis, left hip |
| M08059 | Unspecified juvenile rheumatoid arthritis, unspecified hip |
| M08061 | Unspecified juvenile rheumatoid arthritis, right knee |
| M08062 | Unspecified juvenile rheumatoid arthritis, left knee |
| M08069 | Unspecified juvenile rheumatoid arthritis, unspecified knee |
| M08071 | Unspecified juvenile rheumatoid arthritis, right ankle and foot |
| M08072 | Unspecified juvenile rheumatoid arthritis, left ankle and foot |
| M08079 | Unspecified juvenile rheumatoid arthritis, unspecified ankle and foot |
| M0808 | Unspecified juvenile rheumatoid arthritis, vertebrae |
| M0809 | Unspecified juvenile rheumatoid arthritis, multiple sites |
| M080A | Unspecified juvenile rheumatoid arthritis, other specified site |
| M081 | Juvenile ankylosing spondylitis |
| M0820 | Juvenile rheumatoid arthritis with systemic onset, unspecified site |
| M08211 | Juvenile rheumatoid arthritis with systemic onset, right shoulder |
| M08212 | Juvenile rheumatoid arthritis with systemic onset, left shoulder |
| M08219 | Juvenile rheumatoid arthritis with systemic onset, unspecified shoulder |
| M08221 | Juvenile rheumatoid arthritis with systemic onset, right elbow |
| M08222 | Juvenile rheumatoid arthritis with systemic onset, left elbow |
| M08229 | Juvenile rheumatoid arthritis with systemic onset, unspecified elbow |
| M08231 | Juvenile rheumatoid arthritis with systemic onset, right wrist |
| M08232 | Juvenile rheumatoid arthritis with systemic onset, left wrist |
| M08239 | Juvenile rheumatoid arthritis with systemic onset, unspecified wrist |
| M08241 | Juvenile rheumatoid arthritis with systemic onset, right hand |
| M08242 | Juvenile rheumatoid arthritis with systemic onset, left hand |
| M08249 | Juvenile rheumatoid arthritis with systemic onset, unspecified hand |
| M08251 | Juvenile rheumatoid arthritis with systemic onset, right hip |
| M08252 | Juvenile rheumatoid arthritis with systemic onset, left hip |
| M08259 | Juvenile rheumatoid arthritis with systemic onset, unspecified hip |
| M08261 | Juvenile rheumatoid arthritis with systemic onset, right knee |
| M08262 | Juvenile rheumatoid arthritis with systemic onset, left knee |
| M08269 | Juvenile rheumatoid arthritis with systemic onset, unspecified knee |
| M08271 | Juvenile rheumatoid arthritis with systemic onset, right ankle and foot |
| M08272 | Juvenile rheumatoid arthritis with systemic onset, left ankle and foot |
| M08279 | Juvenile rheumatoid arthritis with systemic onset, unspecified ankle and foot |
| M0828 | Juvenile rheumatoid arthritis with systemic onset, vertebrae |
| M0829 | Juvenile rheumatoid arthritis with systemic onset, multiple sites |
| M082A | Juvenile rheumatoid arthritis with systemic onset, other specified site |
| M083 | Juvenile rheumatoid polyarthritis (seronegative) |
| M0840 | Pauciarticular juvenile rheumatoid arthritis, unspecified site |
| M08411 | Pauciarticular juvenile rheumatoid arthritis, right shoulder |
| M08412 | Pauciarticular juvenile rheumatoid arthritis, left shoulder |
| M08419 | Pauciarticular juvenile rheumatoid arthritis, unspecified shoulder |
| M08421 | Pauciarticular juvenile rheumatoid arthritis, right elbow |
| M08422 | Pauciarticular juvenile rheumatoid arthritis, left elbow |
| M08429 | Pauciarticular juvenile rheumatoid arthritis, unspecified elbow |
| M08431 | Pauciarticular juvenile rheumatoid arthritis, right wrist |
| M08432 | Pauciarticular juvenile rheumatoid arthritis, left wrist |
| M08439 | Pauciarticular juvenile rheumatoid arthritis, unspecified wrist |
| M08441 | Pauciarticular juvenile rheumatoid arthritis, right hand |
| M08442 | Pauciarticular juvenile rheumatoid arthritis, left hand |
| M08449 | Pauciarticular juvenile rheumatoid arthritis, unspecified hand |
| M08451 | Pauciarticular juvenile rheumatoid arthritis, right hip |
| M08452 | Pauciarticular juvenile rheumatoid arthritis, left hip |
| M08459 | Pauciarticular juvenile rheumatoid arthritis, unspecified hip |
| M08461 | Pauciarticular juvenile rheumatoid arthritis, right knee |
| M08462 | Pauciarticular juvenile rheumatoid arthritis, left knee |
| M08469 | Pauciarticular juvenile rheumatoid arthritis, unspecified knee |
| M08471 | Pauciarticular juvenile rheumatoid arthritis, right ankle and foot |
| M08472 | Pauciarticular juvenile rheumatoid arthritis, left ankle and foot |
| M08479 | Pauciarticular juvenile rheumatoid arthritis, unspecified ankle and foot |
| M0848 | Pauciarticular juvenile rheumatoid arthritis, vertebrae |
| M084A | Pauciarticular juvenile rheumatoid arthritis, other specified site |
| M0880 | Other juvenile arthritis, unspecified site |
| M08811 | Other juvenile arthritis, right shoulder |
| M08812 | Other juvenile arthritis, left shoulder |
| M08819 | Other juvenile arthritis, unspecified shoulder |
| M08821 | Other juvenile arthritis, right elbow |
| M08822 | Other juvenile arthritis, left elbow |
| M08829 | Other juvenile arthritis, unspecified elbow |
| M08831 | Other juvenile arthritis, right wrist |
| M08832 | Other juvenile arthritis, left wrist |
| M08839 | Other juvenile arthritis, unspecified wrist |
| M08841 | Other juvenile arthritis, right hand |
| M08842 | Other juvenile arthritis, left hand |
| M08849 | Other juvenile arthritis, unspecified hand |
| M08851 | Other juvenile arthritis, right hip |
| M08852 | Other juvenile arthritis, left hip |
| M08859 | Other juvenile arthritis, unspecified hip |
| M08861 | Other juvenile arthritis, right knee |
| M08862 | Other juvenile arthritis, left knee |
| M08869 | Other juvenile arthritis, unspecified knee |
| M08871 | Other juvenile arthritis, right ankle and foot |
| M08872 | Other juvenile arthritis, left ankle and foot |
| M08879 | Other juvenile arthritis, unspecified ankle and foot |
| M0888 | Other juvenile arthritis, other specified site |
| M0889 | Other juvenile arthritis, multiple sites |
| M0890 | Juvenile arthritis, unspecified, unspecified site |
| M08911 | Juvenile arthritis, unspecified, right shoulder |
| M08912 | Juvenile arthritis, unspecified, left shoulder |
| M08919 | Juvenile arthritis, unspecified, unspecified shoulder |
| M08921 | Juvenile arthritis, unspecified, right elbow |
| M08922 | Juvenile arthritis, unspecified, left elbow |
| M08929 | Juvenile arthritis, unspecified, unspecified elbow |
| M08931 | Juvenile arthritis, unspecified, right wrist |
| M08932 | Juvenile arthritis, unspecified, left wrist |
| M08939 | Juvenile arthritis, unspecified, unspecified wrist |
| M08941 | Juvenile arthritis, unspecified, right hand |
| M08942 | Juvenile arthritis, unspecified, left hand |
| M08949 | Juvenile arthritis, unspecified, unspecified hand |
| M08951 | Juvenile arthritis, unspecified, right hip |
| M08952 | Juvenile arthritis, unspecified, left hip |
| M08959 | Juvenile arthritis, unspecified, unspecified hip |
| M08961 | Juvenile arthritis, unspecified, right knee |
| M08962 | Juvenile arthritis, unspecified, left knee |
| M08969 | Juvenile arthritis, unspecified, unspecified knee |
| M08971 | Juvenile arthritis, unspecified, right ankle and foot |
| M08972 | Juvenile arthritis, unspecified, left ankle and foot |
| M08979 | Juvenile arthritis, unspecified, unspecified ankle and foot |
| M0898 | Juvenile arthritis, unspecified, vertebrae |
| M0899 | Juvenile arthritis, unspecified, multiple sites |
| M089A | Juvenile arthritis, unspecified, other specified site |
| M303 | Mucocutaneous lymph node syndrome [Kawasaki] |
| M310 | Hypersensitivity angiitis |
| M312 | Lethal midline granuloma |
| M3130 | Wegener's granulomatosis without renal involvement |
| M3131 | Wegener's granulomatosis with renal involvement |
| M314 | Aortic arch syndrome [Takayasu] |
| M3300 | Juvenile dermatomyositis, organ involvement unspecified |
| M3301 | Juvenile dermatomyositis with respiratory involvement |
| M3302 | Juvenile dermatomyositis with myopathy |
| M3303 | Juvenile dermatomyositis without myopathy |
| M3309 | Juvenile dermatomyositis with other organ involvement |
| M3310 | Other dermatomyositis, organ involvement unspecified |
| M3311 | Other dermatomyositis with respiratory involvement |
| M3312 | Other dermatomyositis with myopathy |
| M3313 | Other dermatomyositis without myopathy |
| M3319 | Other dermatomyositis with other organ involvement |
| M3320 | Polymyositis, organ involvement unspecified |
| M3321 | Polymyositis with respiratory involvement |
| M3322 | Polymyositis with myopathy |
| M3329 | Polymyositis with other organ involvement |
| M3390 | Dermatopolymyositis, unspecified, organ involvement unspecified |
| M3391 | Dermatopolymyositis, unspecified with respiratory involvement |
| M3392 | Dermatopolymyositis, unspecified with myopathy |
| M3393 | Dermatopolymyositis, unspecified without myopathy |
| M3399 | Dermatopolymyositis, unspecified with other organ involvement |
| M340 | Progressive systemic sclerosis |
| M341 | CR(E)ST syndrome |
| M3481 | Systemic sclerosis with lung involvement |
| M3482 | Systemic sclerosis with myopathy |
| M3483 | Systemic sclerosis with polyneuropathy |
| M3489 | Other systemic sclerosis |
| M349 | Systemic sclerosis, unspecified |
| M360 | Dermato(poly)myositis in neoplastic disease |
| M450 | Ankylosing spondylitis of multiple sites in spine |
| M451 | Ankylosing spondylitis of occipito-atlanto-axial region |
| M452 | Ankylosing spondylitis of cervical region |
| M453 | Ankylosing spondylitis of cervicothoracic region |
| M454 | Ankylosing spondylitis of thoracic region |
| M455 | Ankylosing spondylitis of thoracolumbar region |
| M456 | Ankylosing spondylitis lumbar region |
| M457 | Ankylosing spondylitis of lumbosacral region |
| M458 | Ankylosing spondylitis sacral and sacrococcygeal region |
| M459 | Ankylosing spondylitis of unspecified sites in spine |
| M45A0 | Non-radiographic axial spondyloarthritis of unspecified sites in spine |
| M45A1 | Non-radiographic axial spondyloarthritis of occipito-atlanto-axial region |
| M45A2 | Non-radiographic axial spondyloarthritis of cervical region |
| M45A3 | Non-radiographic axial spondyloarthritis of cervicothoracic region |
| M45A4 | Non-radiographic axial spondyloarthritis of thoracic region |
| M45A5 | Non-radiographic axial spondyloarthritis of thoracolumbar region |
| M45A6 | Non-radiographic axial spondyloarthritis of lumbar region |
| M45A7 | Non-radiographic axial spondyloarthritis of lumbosacral region |
| M45A8 | Non-radiographic axial spondyloarthritis of sacral and sacrococcygeal region |
| M45AB | Non-radiographic axial spondyloarthritis of multiple sites in spine |
| M488X1 | Other specified spondylopathies, occipito-atlanto-axial region |
| M488X2 | Other specified spondylopathies, cervical region |
| M488X3 | Other specified spondylopathies, cervicothoracic region |
| M488X4 | Other specified spondylopathies, thoracic region |
| M488X5 | Other specified spondylopathies, thoracolumbar region |
| M488X6 | Other specified spondylopathies, lumbar region |
| M488X7 | Other specified spondylopathies, lumbosacral region |
| M488X8 | Other specified spondylopathies, sacral and sacrococcygeal region |
| M488X9 | Other specified spondylopathies, site unspecified |
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 |
|---|---|
| 40 | 505 |
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 93?
508 ICD-10-CM codes map to HCC 93 in the CMS PY2027 initial mapping, for example D8686 Sarcoid arthropathy; D8687 Sarcoid myositis; G7241 Inclusion body myositis [IBM]; I7782 Antineutrophilic cytoplasmic antibody [ANCA] vasculitis. 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 93 add to a risk score?
The V28 relative factor for HCC 93 is 0.617 for a community, non-dual, aged beneficiary, 0.439 for full-benefit dual aged, 0.470 for non-dual disabled and 0.297 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 93 count together with related categories?
No. Within a hierarchy only the most severe category is paid. HCC 93 is the most severe category in its hierarchy, and it drops HCC 94 when it is present.
What has to be documented for HCC 93 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.