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 17 | Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic | 78 | 4.209 | 3.995 | 1.952 |
| HCC 18 | Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid | 26 | 2.341 | 2.486 | 1.110 |
| HCC 19 | Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers | 68 | 1.798 | 1.989 | 0.957 |
| HCC 20 | Lung and Other Severe Cancers | 233 | 1.136 | 0.978 | 0.672 |
| HCC 21 | Lymphoma and Other Cancers | 463 | 0.671 | 0.540 | 0.493 |
| HCC 22 | Bladder, Colorectal, and Other Cancers | 126 | 0.363 | 0.366 | 0.314 |
| HCC 23 | Prostate, Breast, and Other Cancers and Tumors | 234 | 0.186 | 0.233 | 0.197 |
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 17 (Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic) > HCC 18 (Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid) > HCC 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers) > HCC 20 (Lung and Other Severe Cancers) > HCC 21 (Lymphoma and Other Cancers) > HCC 22 (Bladder, Colorectal, and Other Cancers) > HCC 23 (Prostate, Breast, and Other Cancers and Tumors)
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 |
|---|---|---|---|
| Disabled and cancer (institutional) | 0.367 |
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 |
|---|---|
| C82 | 99 |
| C84 | 89 |
| C83 | 78 |
| C81 | 77 |
| C50 | 57 |
| C85 | 44 |
| C92 | 30 |
| C69 | 27 |
Where these codes sat in V24
The payment year 2025 mapping lists the V24 and V28 category for the same codes. 25 codes in this group had no V24 payment category. The main V24 sources are below; the crosswalk report covers every category.
| V24 HCC | V24 category | Codes |
|---|---|---|
| 10 | Lymphoma and Other Cancers | 595 |
| 12 | Breast, Prostate, and Other Cancers and Tumors | 271 |
| 11 | Colorectal, Bladder, and Other Cancers | 133 |
| 9 | Lung and Other Severe Cancers | 110 |
| 8 | Metastatic Cancer and Acute Leukemia | 82 |
| 46 | Severe Hematological Disorders | 13 |
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 820 | Lymphoma and Leukemia with Major O.R. Procedures with MCC | 546 |
| DRG 821 | Lymphoma and Leukemia with Major O.R. Procedures with CC | 546 |
| DRG 822 | Lymphoma and Leukemia with Major O.R. Procedures without CC/MCC | 546 |
| DRG 823 | Lymphoma and Non-Acute Leukemia with Other Procedures with MCC | 469 |
| DRG 824 | Lymphoma and Non-Acute Leukemia with Other Procedures with CC | 469 |
| DRG 825 | Lymphoma and Non-Acute Leukemia with Other Procedures without CC/MCC | 469 |
| DRG 840 | Lymphoma and Non-Acute Leukemia with MCC | 469 |
| DRG 841 | Lymphoma and Non-Acute Leukemia with CC | 469 |
FY2027 code changes in this group
The October 1, 2026 ICD-10-CM update deleted 0 codes mapped to this group and created 3 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 cancer 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 cancer group?
HCC 17 (Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic, 78 codes, factor 4.209); HCC 18 (Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid, 26 codes, factor 2.341); HCC 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers, 68 codes, factor 1.798); HCC 20 (Lung and Other Severe Cancers, 233 codes, factor 1.136); HCC 21 (Lymphoma and Other Cancers, 463 codes, factor 0.671); HCC 22 (Bladder, Colorectal, and Other Cancers, 126 codes, factor 0.363); HCC 23 (Prostate, Breast, and Other Cancers and Tumors, 234 codes, factor 0.186).
Which cancer HCC has the most mapped ICD-10-CM codes?
HCC 21, Lymphoma and Other Cancers, with 463 codes in the PY2027 initial mapping; across the group the largest code families are C82 (99), C84 (89), C83 (78), C81 (77).
Where did the cancer codes sit in the V24 model?
In the PY2025 mapping, which carries both models, 1,240 code-to-category links point to this group; 25 of those codes had no V24 payment category. The main V24 sources were HCC 10 (Lymphoma and Other Cancers, 595), HCC 12 (Breast, Prostate, and Other Cancers and Tumors, 271), HCC 11 (Colorectal, Bladder, and Other Cancers, 133).
Do cancer HCCs interact with other conditions in V28?
Yes. Disabled and cancer (institutional) adds 0.367 (long-term institutional only). 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.