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Infections HCCs in CMS-HCC V28 (HCC 1-6)

The infections group of the CMS-HCC V28 model holds 3 payment categories (HCC 1, 2, 6): HIV/AIDS, sepsis and opportunistic infections. 92 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.301 (HCC 1) to 0.500 (HCC 2). 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
3
Mapped ICD-10-CM codes
92
Factor range (CNA)
0.301 to 0.500
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 infections categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 1HIV/AIDS30.3010.2131.322
HCC 2Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock520.5000.5980.605
HCC 6Opportunistic Infections370.3810.7630.728

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 infections group
ICD-10-CM categoryMapped codes
A4115
P3610
B468
B457
B446
A405
B255
B374

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 infections V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
2Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock52
6Opportunistic Infections38
1HIV/AIDS3
173Traumatic Amputations and Complications1

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 infections HCC codes
MS-DRGTitleShared codes
DRG 791Prematurity with Major Problems57
DRG 793Full Term Neonate with Major Problems57
DRG 870Septicemia or Severe Sepsis with MV >96 Hours36
DRG 871Septicemia or Severe Sepsis without MV >96 Hours with MCC36
DRG 872Septicemia or Severe Sepsis without MV >96 Hours without MCC36
DRG 974HIV with Major Related Condition with MCC35
DRG 975HIV with Major Related Condition with CC35
DRG 976HIV with Major Related Condition without CC/MCC35

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted 0 codes mapped to this group and created 1 replacement code 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 infections 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 infections group?

HCC 1 (HIV/AIDS, 3 codes, factor 0.301); HCC 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock, 52 codes, factor 0.500); HCC 6 (Opportunistic Infections, 37 codes, factor 0.381).

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

HCC 2, Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock, with 52 codes in the PY2027 initial mapping; across the group the largest code families are A41 (15), P36 (10), B46 (8), B45 (7).

Where did the infections codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 92 code-to-category links point to this group; 0 of those codes had no V24 payment category. The main V24 sources were HCC 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock, 52), HCC 6 (Opportunistic Infections, 38), HCC 1 (HIV/AIDS, 3).

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.