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Metabolic and endocrine HCCs in CMS-HCC V28 (HCC 48-51)

The metabolic and endocrine group of the CMS-HCC V28 model holds 4 payment categories (HCC 48, 49, 50, 51): morbid obesity, storage and metabolic disorders, endocrine disorders. 65 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.186 (HCC 48) to 9.256 (HCC 49). 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
4
Mapped ICD-10-CM codes
65
Factor range (CNA)
0.186 to 9.256
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 metabolic and endocrine categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 48Morbid Obesity90.1860.1440.442
HCC 49Specified Lysosomal Storage Disorders139.25613.7781.528
HCC 50Amyloidosis, Porphyria, and Other Specified Metabolic Disorders320.6480.8830.362
HCC 51Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders110.5100.6060.620

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 metabolic and endocrine group
ICD-10-CM categoryMapped codes
E7610
E859
E318
E747
E806
Z686
E724
E834

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 metabolic and endocrine V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
23Other Significant Endocrine and Metabolic Disorders49
22Morbid Obesity9

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 metabolic and endocrine HCC codes
MS-DRGTitleShared codes
DRG 642Inborn and Other Disorders of Metabolism35
DRG 643Endocrine Disorders with MCC11
DRG 644Endocrine Disorders with CC11
DRG 645Endocrine Disorders without CC/MCC11
DRG 545Connective Tissue Disorders with MCC9
DRG 546Connective Tissue Disorders with CC9
DRG 547Connective Tissue Disorders without CC/MCC9
DRG 640Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes with MCC8

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 metabolic and endocrine 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 metabolic and endocrine group?

HCC 48 (Morbid Obesity, 9 codes, factor 0.186); HCC 49 (Specified Lysosomal Storage Disorders, 13 codes, factor 9.256); HCC 50 (Amyloidosis, Porphyria, and Other Specified Metabolic Disorders, 32 codes, factor 0.648); HCC 51 (Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders, 11 codes, factor 0.510).

Which metabolic and endocrine HCC has the most mapped ICD-10-CM codes?

HCC 50, Amyloidosis, Porphyria, and Other Specified Metabolic Disorders, with 32 codes in the PY2027 initial mapping; across the group the largest code families are E76 (10), E85 (9), E31 (8), E74 (7).

Where did the metabolic and endocrine codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 62 code-to-category links point to this group; 4 of those codes had no V24 payment category. The main V24 sources were HCC 23 (Other Significant Endocrine and Metabolic Disorders, 49), HCC 22 (Morbid Obesity, 9).

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.