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Injury HCCs in CMS-HCC V28 (HCC 397-409)

The injury group of the CMS-HCC V28 model holds 7 payment categories (HCC 397, 398, 399, 401, 402, 405, 409): head injuries, fractures, amputations and amputation status. 1,542 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.199 (HCC 397) to 0.598 (HCC 409). 2 hierarchies rank HCC 397 > 398 > 399 and HCC 405 > 409, 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
1542
Factor range (CNA)
0.199 to 0.598
Hierarchies in the group
2
CMS hierarchy group "Injury"

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 injury categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 397Major Head Injury with Loss of Consciousness > 1 Hour760.1990.1500.085
HCC 398Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified570.1990.1500.085
HCC 399Major Head Injury without Loss of Consciousness1890.1990.1500.085
HCC 401Vertebral Fractures without Spinal Cord Injury3390.5220.6050.231
HCC 402Hip Fracture/Dislocation7290.4670.5610.089
HCC 405Traumatic Amputations and Complications1080.5980.5770.284
HCC 409Amputation Status, Lower Limb/Amputation Complications440.5980.5620.284

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 397 (Major Head Injury with Loss of Consciousness > 1 Hour) > HCC 398 (Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified) > HCC 399 (Major Head Injury without Loss of Consciousness)
  • HCC 405 (Traumatic Amputations and Complications) > HCC 409 (Amputation Status, Lower Limb/Amputation Complications)

The macro also ranks some of these categories against categories in other groups:

  • HCC 397 (Major Head Injury with Loss of Consciousness > 1 Hour) drops HCC 202 (Neurological)
  • HCC 398 (Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified) drops HCC 202 (Neurological)
  • HCC 409 (Amputation Status, Lower Limb/Amputation Complications) is dropped by HCC 263 (Vascular)

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 injury group
ICD-10-CM categoryMapped codes
S72462
S32282
S06173
S02148
S12140
S2290
S7330
S7927

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. 4 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 injury V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
170Hip Fracture/Dislocation729
169Vertebral Fractures without Spinal Cord Injury339
167Major Head Injury245
173Traumatic Amputations and Complications108
166Severe Head Injury76
189Amputation Status, Lower Limb/Amputation Complications41

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 injury HCC codes
MS-DRGTitleShared codes
DRG 963Other Multiple Significant Trauma with MCC1454
DRG 964Other Multiple Significant Trauma with CC1454
DRG 965Other Multiple Significant Trauma without CC/MCC1454
DRG 535Fractures of Hip and Pelvis with MCC400
DRG 536Fractures of Hip and Pelvis without MCC400
DRG 791Prematurity with Major Problems377
DRG 793Full Term Neonate with Major Problems377
DRG 521Hip Replacement with Principal Diagnosis of Hip Fracture with MCC348

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 injury 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 injury group?

HCC 397 (Major Head Injury with Loss of Consciousness > 1 Hour, 76 codes, factor 0.199); HCC 398 (Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified, 57 codes, factor 0.199); HCC 399 (Major Head Injury without Loss of Consciousness, 189 codes, factor 0.199); HCC 401 (Vertebral Fractures without Spinal Cord Injury, 339 codes, factor 0.522); HCC 402 (Hip Fracture/Dislocation, 729 codes, factor 0.467); HCC 405 (Traumatic Amputations and Complications, 108 codes, factor 0.598); HCC 409 (Amputation Status, Lower Limb/Amputation Complications, 44 codes, factor 0.598).

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

HCC 402, Hip Fracture/Dislocation, with 729 codes in the PY2027 initial mapping; across the group the largest code families are S72 (462), S32 (282), S06 (173), S02 (148).

Where did the injury codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 1,542 code-to-category links point to this group; 4 of those codes had no V24 payment category. The main V24 sources were HCC 170 (Hip Fracture/Dislocation, 729), HCC 169 (Vertebral Fractures without Spinal Cord Injury, 339), HCC 167 (Major Head Injury, 245).

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.