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Blood and immune HCCs in CMS-HCC V28 (HCC 107-115)

The blood and immune group of the CMS-HCC V28 model holds 7 payment categories (HCC 107, 108, 109, 111, 112, 114, 115): sickle cell disorders, anemias, hemophilia, thrombocytopenia and immunodeficiency. 150 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.146 (HCC 108) to 4.639 (HCC 111). 3 hierarchies rank HCC 107 > 108 and HCC 111 > 112 and HCC 114 > 115, so a member is paid for at most one category in each chain.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); CMS-HCC V28 model software: CMS-HCC V28 software V2826.115.T2 (PY2027 initial) (payment year 2027). Next CMS release: PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027).

Payment categories
7
Mapped ICD-10-CM codes
150
Factor range (CNA)
0.146 to 4.639
Hierarchies in the group
3
CMS hierarchy group "Blood"

Categories and relative factors

Each factor is added to the member's demographic factors when the category is documented in the data collection year. Community, non-dual, aged (CNA) is the largest segment; the disabled (CND) and long-term institutional (INS) segments are estimated separately, which is why the same category is worth a different amount for each.

CMS-HCC V28 blood and immune categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 107Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero140.4571.4490.692
HCC 108Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major390.1460.3860.098
HCC 109Acquired Hemolytic, Aplastic, and Sideroblastic Anemias371.1441.8150.529
HCC 111Hemophilia, Male24.63930.7066.310
HCC 112Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions210.4500.6400.516
HCC 114Common Variable and Combined Immunodeficiencies182.2622.5980.691
HCC 115Specified Immunodeficiencies and White Blood Cell Disorders190.5650.6920.691

Hierarchy inside the group

The V28 hierarchy macro ranks related categories so that a member with codes in several of them is paid only for the higher-ranked one. Each category drops only the categories its own macro entry lists.

Read each chain left to right: every category drops every category to its right, so a member is paid for at most one category per chain.

  • HCC 107 (Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero) > HCC 108 (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major)
  • HCC 111 (Hemophilia, Male) > HCC 112 (Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions)
  • HCC 114 (Common Variable and Combined Immunodeficiencies) > HCC 115 (Specified Immunodeficiencies and White Blood Cell Disorders)

ICD-10-CM code families

Where the mapped codes concentrate. A family with many codes is usually where specificity matters most: the category only counts when the documented diagnosis supports the exact code reported.

Three-character ICD-10-CM categories with the most codes in the blood and immune group
ICD-10-CM categoryMapped codes
D5742
D5914
D8114
D6813
D619
H368
D695
D805

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. 8 codes in this group had no V24 payment category. The main V24 sources are below; the crosswalk report covers every category.

V24 categories behind the blood and immune V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
46Severe Hematological Disorders77
47Disorders of Immunity34
48Coagulation Defects and Other Specified Hematological Disorders25
122Proliferative Diabetic Retinopathy and Vitreous Hemorrhage4
40Rheumatoid Arthritis and Inflammatory Connective Tissue Disease2
23Other Significant Endocrine and Metabolic Disorders1

The CMS-HCC V24 vs V28 crosswalk shows the codes that lost or gained payment status across all categories.

Inpatient MS-DRGs that use these diagnoses

Appendix B of the v44 MS-DRG Definitions Manual names the DRGs whose logic uses each diagnosis. The same documentation supports the inpatient group and, for Medicare Advantage members, the risk score.

MS-DRGs whose logic lists the most blood and immune HCC codes
MS-DRGTitleShared codes
DRG 811Red Blood Cell Disorders with MCC53
DRG 812Red Blood Cell Disorders without MCC53
DRG 791Prematurity with Major Problems39
DRG 793Full Term Neonate with Major Problems39
DRG 808Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and Coagulation Disorders with MCC38
DRG 809Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and Coagulation Disorders with CC38
DRG 810Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and Coagulation Disorders without CC/MCC38
DRG 813Coagulation Disorders20

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted 1 code mapped to this group and created 2 replacement codes whose predecessors map here. CMS has not mapped the new codes yet; each category page lists them as pending. The FY2027 code changes report lists every new and deleted code.

Where QuickIntell fits for blood and immune HCCs

An HCC counts only when the visit note supports it. QuickScribe captures the encounter documentation, and QuickCode supports qualified coder review and documentation clarification before diagnoses are submitted.

See QuickScribe for visit documentationSee QuickCode for coder reviewBook a meeting

Frequently asked questions

Which HCCs are in the V28 blood and immune group?

HCC 107 (Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero, 14 codes, factor 0.457); HCC 108 (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major, 39 codes, factor 0.146); HCC 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias, 37 codes, factor 1.144); HCC 111 (Hemophilia, Male, 2 codes, factor 4.639); HCC 112 (Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions, 21 codes, factor 0.450); HCC 114 (Common Variable and Combined Immunodeficiencies, 18 codes, factor 2.262); HCC 115 (Specified Immunodeficiencies and White Blood Cell Disorders, 19 codes, factor 0.565).

Which blood and immune HCC has the most mapped ICD-10-CM codes?

HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major, with 39 codes in the PY2027 initial mapping; across the group the largest code families are D57 (42), D59 (14), D81 (14), D68 (13).

Where did the blood and immune codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 147 code-to-category links point to this group; 8 of those codes had no V24 payment category. The main V24 sources were HCC 46 (Severe Hematological Disorders, 77), HCC 47 (Disorders of Immunity, 34), HCC 48 (Coagulation Defects and Other Specified Hematological Disorders, 25).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Factors, hierarchies and mappings are reproduced from the CMS risk adjustment model files as an operational reference. The group is a navigation aid built from the V28 hierarchy; CMS pays categories, not groups. Payment depends on the plan's base rate, normalization, the coding intensity adjustment and the enrollee's segment. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.