Skip to main content

Eye HCCs in CMS-HCC V28 (HCC 298-300)

The eye group of the CMS-HCC V28 model holds 2 payment categories (HCC 298, 300): proliferative diabetic retinopathy and exudative macular degeneration. 196 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.336 (HCC 298) to 0.596 (HCC 300). None of these categories overrides another, so each is paid whenever it is documented.

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
2
Mapped ICD-10-CM codes
196
Factor range (CNA)
0.336 to 0.596
Hierarchies in the group
0
Grouped by category number; no CMS hierarchy

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 eye categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 298Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage1800.3360.3640.545
HCC 300Exudative Macular Degeneration160.5960.3660.196

Hierarchy inside the group

No category in this group overrides another in the V28 hierarchy, so each one adds its factor whenever a mapped diagnosis is documented and supported, even when the member also has another category from the group.

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 eye group
ICD-10-CM categoryMapped codes
E0837
E1037
E1137
E1337
H3424
H3516
H364
H434

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. 24 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 eye V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
18Diabetes with Chronic Complications148
122Proliferative Diabetic Retinopathy and Vitreous Hemorrhage104
124Exudative Macular Degeneration16
46Severe Hematological Disorders4

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 eye HCC codes
MS-DRGTitleShared codes
DRG 124Other Disorders of the Eye with MCC or Thrombolytic Agent172
DRG 125Other Disorders of the Eye without MCC172
DRG 008Simultaneous Pancreas, Islet Cell and Kidney Transplant148
DRG 010Pancreas or Islet Cell Transplant148
DRG 019Simultaneous Pancreas, Islet Cell and Kidney Transplant with Hemodialysis148
DRG 123Neurological Eye Disorders24

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 eye 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 eye group?

HCC 298 (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage, 180 codes, factor 0.336); HCC 300 (Exudative Macular Degeneration, 16 codes, factor 0.596).

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

HCC 298, Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage, with 180 codes in the PY2027 initial mapping; across the group the largest code families are E08 (37), E10 (37), E11 (37), E13 (37).

Where did the eye codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 196 code-to-category links point to this group; 24 of those codes had no V24 payment category. The main V24 sources were HCC 18 (Diabetes with Chronic Complications, 148), HCC 122 (Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, 104), HCC 124 (Exudative Macular Degeneration, 16).

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.