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.
| HCC | Category | Codes | CNA | CND | INS |
|---|---|---|---|---|---|
| HCC 326 | Chronic Kidney Disease, Stage 5 | 5 | 0.815 | 0.927 | 0.958 |
| HCC 327 | Chronic Kidney Disease, Severe (Stage 4) | 1 | 0.514 | 0.523 | 0.462 |
| HCC 328 | Chronic Kidney Disease, Moderate (Stage 3B) | 1 | 0.127 | 0.179 | 0.145 |
| HCC 329 | Chronic Kidney Disease, Moderate (Stage 3, Except 3B) | 2 | 0.127 | 0.179 | 0.145 |
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.
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.
| Interaction | CNA | CND | INS |
|---|---|---|---|
| Heart failure and kidney disease | 0.176 | 0.314 | 0.000 |
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.
| ICD-10-CM category | Mapped codes |
|---|---|
| N18 | 6 |
| I13 | 2 |
| I12 | 1 |
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 HCC | V24 category | Codes |
|---|---|---|
| 136 | Chronic Kidney Disease, Stage 5 | 5 |
| 138 | Chronic Kidney Disease, Moderate (Stage 3) | 3 |
| 85 | Congestive Heart Failure | 1 |
| 137 | Chronic Kidney Disease, Severe (Stage 4) | 1 |
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-DRG | Title | Shared codes |
|---|---|---|
| DRG 008 | Simultaneous Pancreas, Islet Cell and Kidney Transplant | 9 |
| DRG 019 | Simultaneous Pancreas, Islet Cell and Kidney Transplant with Hemodialysis | 9 |
| DRG 682 | Renal Failure with MCC | 8 |
| DRG 683 | Renal Failure with CC | 8 |
| DRG 684 | Renal Failure without CC/MCC | 8 |
| DRG 673 | Other Kidney and Urinary Tract Procedures with MCC | 4 |
| DRG 674 | Other Kidney and Urinary Tract Procedures with CC | 4 |
| DRG 675 | Other Kidney and Urinary Tract Procedures without CC/MCC | 4 |
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 kidney 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.
Frequently asked questions
Which HCCs are in the V28 kidney group?
HCC 326 (Chronic Kidney Disease, Stage 5, 5 codes, factor 0.815); HCC 327 (Chronic Kidney Disease, Severe (Stage 4), 1 codes, factor 0.514); HCC 328 (Chronic Kidney Disease, Moderate (Stage 3B), 1 codes, factor 0.127); HCC 329 (Chronic Kidney Disease, Moderate (Stage 3, Except 3B), 2 codes, factor 0.127).
Which kidney HCC has the most mapped ICD-10-CM codes?
HCC 326, Chronic Kidney Disease, Stage 5, with 5 codes in the PY2027 initial mapping; across the group the largest code families are N18 (6), I13 (2), I12 (1).
Where did the kidney codes sit in the V24 model?
In the PY2025 mapping, which carries both models, 9 code-to-category links point to this group; 0 of those codes had no V24 payment category. The main V24 sources were HCC 136 (Chronic Kidney Disease, Stage 5, 5), HCC 138 (Chronic Kidney Disease, Moderate (Stage 3), 3), HCC 85 (Congestive Heart Failure, 1).
Do kidney HCCs interact with other conditions in V28?
Yes. Heart failure and kidney disease adds 0.176 (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.
- ICD-10-CM to CMS-HCC V28 mappings, payment year 2027 initialVersion PY2027 initial ICD-10-CM mappings (dates of service 2026) · effective 2027-01-01 · file 2027 Initial ICD-10-CM Mappings.csvSHA-256 9c260b06d0dd2806…
- CMS-HCC V28 model software: labels, hierarchies and relative factorsVersion CMS-HCC V28 software V2826.115.T2 (PY2027 initial) · effective 2027-01-01 · file C2824T2N.csvSHA-256 20f38d537493b41c…
- ICD-10-CM to CMS-HCC V24 and V28 mappings, payment year 2025 midyear/finalVersion PY2025 midyear/final ICD-10-CM mappings (dates of service 2024) · effective 2025-01-01 · file 2025 Midyear_Final ICD-10-CM Mappings.csvSHA-256 719bd3842ddccb1c…
- ICD-10 MS-DRG Definitions Manual v44 (text)Version v44 · effective 2026-10-01 · file fy2027-fr-icd10-ms-drg-definitions-manual-files-v44.zipSHA-256 ae4f6c11727fe91f…
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.