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Musculoskeletal HCCs in CMS-HCC V28 (HCC 92-94)

The musculoskeletal group of the CMS-HCC V28 model holds 3 payment categories (HCC 92, 93, 94): bone and joint infections, rheumatoid arthritis and lupus. 1,188 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.268 (HCC 94) to 0.617 (HCC 93). One hierarchy ranks HCC 93 > 94, so a member is paid for at most one category in the 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
3
Mapped ICD-10-CM codes
1188
Factor range (CNA)
0.268 to 0.617
Hierarchies in the group
1
CMS hierarchy group "MSK"

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 musculoskeletal categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 92Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis6090.4790.5290.556
HCC 93Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders5080.6170.4700.297
HCC 94Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders710.2680.2390.297

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 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders) > HCC 94 (Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders)

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 musculoskeletal group
ICD-10-CM categoryMapped codes
M05211
M86179
M87173
M08125
M06101
M0097
M0273
M0124

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 musculoskeletal V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
39Bone/Joint/Muscle Infections/Necrosis608
40Rheumatoid Arthritis and Inflammatory Connective Tissue Disease573
75Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy24
112Fibrosis of Lung and Other Chronic Lung Disorders6
108Vascular Disease2

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 musculoskeletal HCC codes
MS-DRGTitleShared codes
DRG 545Connective Tissue Disorders with MCC521
DRG 546Connective Tissue Disorders with CC521
DRG 547Connective Tissue Disorders without CC/MCC521
DRG 553Bone Diseases and Arthropathies with MCC248
DRG 554Bone Diseases and Arthropathies without MCC248
DRG 539Osteomyelitis with MCC192
DRG 540Osteomyelitis with CC192
DRG 541Osteomyelitis without CC/MCC192

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted 8 codes mapped to this group and created 25 replacement codes 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 musculoskeletal 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 musculoskeletal group?

HCC 92 (Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis, 609 codes, factor 0.479); HCC 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders, 508 codes, factor 0.617); HCC 94 (Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders, 71 codes, factor 0.268).

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

HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis, with 609 codes in the PY2027 initial mapping; across the group the largest code families are M05 (211), M86 (179), M87 (173), M08 (125).

Where did the musculoskeletal codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 1,187 code-to-category links point to this group; 4 of those codes had no V24 payment category. The main V24 sources were HCC 39 (Bone/Joint/Muscle Infections/Necrosis, 608), HCC 40 (Rheumatoid Arthritis and Inflammatory Connective Tissue Disease, 573), HCC 75 (Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy, 24).

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.