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Vascular HCCs in CMS-HCC V28 (HCC 263-267)

The vascular group of the CMS-HCC V28 model holds 3 payment categories (HCC 263, 264, 267): atherosclerosis with complications, vascular disease with complications, DVT and PE. 365 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.294 (HCC 267) to 1.118 (HCC 263). One hierarchy ranks HCC 263 > 264, 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
365
Factor range (CNA)
0.294 to 1.118
Hierarchies in the group
1
CMS hierarchy group "Vascular"

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 vascular categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 263Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene1271.1181.0660.696
HCC 264Vascular Disease with Complications710.4550.5200.338
HCC 267Deep Vein Thrombosis and Pulmonary Embolism1670.2940.4310.245

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 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) > HCC 264 (Vascular Disease with Complications)

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

  • HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) drops HCC 383 (Skin ulcers and burns) and HCC 409 (Injury)

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 vascular group
ICD-10-CM categoryMapped codes
I70150
I82120
I8032
I7119
I2612
I7411
I7510
T792

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 categories behind the vascular V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
108Vascular Disease182
106Atherosclerosis of the Extremities with Ulceration or Gangrene127
161Chronic Ulcer of Skin, Except Pressure90
107Vascular Disease with Complications54
85Congestive Heart Failure5
18Diabetes with Chronic Complications4

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 vascular HCC codes
MS-DRGTitleShared codes
DRG 299Peripheral Vascular Disorders with MCC345
DRG 300Peripheral Vascular Disorders with CC345
DRG 301Peripheral Vascular Disorders without CC/MCC345
DRG 791Prematurity with Major Problems68
DRG 793Full Term Neonate with Major Problems68
DRG 175Pulmonary Embolism with MCC or Acute Cor Pulmonale15
DRG 176Pulmonary Embolism without MCC15
DRG 173Ultrasound Accelerated and Other Thrombolysis with Principal Diagnosis Pulmonary Embolism13

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 vascular 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 vascular group?

HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene, 127 codes, factor 1.118); HCC 264 (Vascular Disease with Complications, 71 codes, factor 0.455); HCC 267 (Deep Vein Thrombosis and Pulmonary Embolism, 167 codes, factor 0.294).

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

HCC 267, Deep Vein Thrombosis and Pulmonary Embolism, with 167 codes in the PY2027 initial mapping; across the group the largest code families are I70 (150), I82 (120), I80 (32), I71 (19).

Where did the vascular codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 365 code-to-category links point to this group; 0 of those codes had no V24 payment category. The main V24 sources were HCC 108 (Vascular Disease, 182), HCC 106 (Atherosclerosis of the Extremities with Ulceration or Gangrene, 127), HCC 161 (Chronic Ulcer of Skin, Except Pressure, 90).

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.

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