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Diabetes HCCs in CMS-HCC V28 (HCC 35-38)

The diabetes group of the CMS-HCC V28 model holds 4 payment categories (HCC 35, 36, 37, 38): diabetes by complication, plus pancreas transplant status. 344 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.166 (HCC 36) to 0.949 (HCC 35). One hierarchy ranks HCC 35 > 36 > 37 > 38, so a member is paid for at most one category in the 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
4
Mapped ICD-10-CM codes
344
Factor range (CNA)
0.166 to 0.949
Hierarchies in the group
1
CMS hierarchy group "Diabetes"

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 diabetes categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 35Pancreas Transplant Status10.9491.3931.106
HCC 36Diabetes with Severe Acute Complications180.1660.1910.280
HCC 37Diabetes with Chronic Complications3080.1660.1910.280
HCC 38Diabetes with Glycemic, Unspecified, or No Complications170.1660.1910.280

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 35 (Pancreas Transplant Status) > HCC 36 (Diabetes with Severe Acute Complications) > HCC 37 (Diabetes with Chronic Complications) > HCC 38 (Diabetes with Glycemic, Unspecified, or No Complications)

Interaction terms that involve this group

V28 pays an extra factor when two condition groups are documented together, on top of each category's own factor. A blank cell means the segment carries no such term.

V28 interaction factors involving diabetes categories
InteractionCNACNDINS
Diabetes and heart failure0.1120.0230.209

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 diabetes group
ICD-10-CM categoryMapped codes
E0886
E1186
E1386
E1084
Z791
Z941

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. Every code in this group already had a V24 payment category. The main V24 sources are below; the crosswalk report covers every category.

V24 categories behind the diabetes V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
18Diabetes with Chronic Complications320
122Proliferative Diabetic Retinopathy and Vitreous Hemorrhage96
17Diabetes with Acute Complications18
161Chronic Ulcer of Skin, Except Pressure8
19Diabetes without Complication5
106Atherosclerosis of the Extremities with Ulceration or Gangrene4

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 diabetes HCC codes
MS-DRGTitleShared codes
DRG 008Simultaneous Pancreas, Islet Cell and Kidney Transplant338
DRG 010Pancreas or Islet Cell Transplant338
DRG 019Simultaneous Pancreas, Islet Cell and Kidney Transplant with Hemodialysis338
DRG 124Other Disorders of the Eye with MCC or Thrombolytic Agent224
DRG 125Other Disorders of the Eye without MCC224
DRG 637Diabetes with MCC66
DRG 638Diabetes with CC66
DRG 639Diabetes without CC/MCC66

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted no code mapped to this group, so its code lists carry into FY2027 unchanged until CMS posts a mapping for the new code set. The FY2027 code changes report lists every new and deleted code.

Where QuickIntell fits for diabetes 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 diabetes group?

HCC 35 (Pancreas Transplant Status, 1 codes, factor 0.949); HCC 36 (Diabetes with Severe Acute Complications, 18 codes, factor 0.166); HCC 37 (Diabetes with Chronic Complications, 308 codes, factor 0.166); HCC 38 (Diabetes with Glycemic, Unspecified, or No Complications, 17 codes, factor 0.166).

Which diabetes HCC has the most mapped ICD-10-CM codes?

HCC 37, Diabetes with Chronic Complications, with 308 codes in the PY2027 initial mapping; across the group the largest code families are E08 (86), E11 (86), E13 (86), E10 (84).

Where did the diabetes codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 344 code-to-category links point to this group; 0 of those codes had no V24 payment category. The main V24 sources were HCC 18 (Diabetes with Chronic Complications, 320), HCC 122 (Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, 96), HCC 17 (Diabetes with Acute Complications, 18).

Do diabetes HCCs interact with other conditions in V28?

Yes. Diabetes and heart failure adds 0.112 (community, non-dual, aged). Each term is added on top of the category factors when both conditions are documented.

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.