Headline numbers
- Codes with a V24 payment HCC
- 9,927
- Codes with a V28 payment HCC
- 7,903
- Lost a payment HCC
- 2,252
- 22.7% of V24-mapped codes
- Gained a payment HCC
- 228
- Followed their V24 category
- 6,580
- Mapped to the V28 category that took most of their V24 category
- Split from their V24 category
- 1,095
- Mapped to a different V28 category than most of their V24 peers
Download the code-level crosswalk as a CSV file (ICD-10-CM code, description, V24 HCC, V28 HCC and status). Because the two models number their categories independently, “followed” and “split” are measured against the V28 category that received most of each V24 category's codes, not against the category number. As a cross-check, the ESRD V24 column of the same file matches the CMS-HCC V24 column on all 11,725 rows (0 differences).
How V28 replaced V24
CMS phased the 2024 CMS-HCC model in over three payment years, as set out in the CY2024, CY2025 and CY2026 Rate Announcements. The blend applies to risk scores for Medicare Advantage plans; PACE organizations stayed on the 2017 model (V22).
| Payment year | 2020 model (V24) | 2024 model (V28) |
|---|---|---|
| 2024 | 67% | 33% |
| 2025 | 33% | 67% |
| 2026 and later | 0% | 100% |
Nothing in the model moved between the last two releases: the PY2027 initial mapping file is byte-identical to the PY2026 midyear final file, and V28 software V2826.115.T2 carries the same relative factors as V2826.115.T1. The CMS-HCC V24 glossary entry and the V28 model definition cover the policy background.
The largest category-to-category moves
Each row counts the codes that mapped to the V24 category and to the V28 category in the same release. The biggest pairs show where V28 kept a V24 category almost intact under a new number, such as V24 HCC 18 becoming V28 HCC 37.
| V24 HCC | V24 category | V28 HCC | V28 category | Codes |
|---|---|---|---|---|
| 170 | Hip Fracture/Dislocation | 402 | Hip Fracture/Dislocation | 729 |
| 39 | Bone/Joint/Muscle Infections/Necrosis | 92 | Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis | 608 |
| 40 | Rheumatoid Arthritis and Inflammatory Connective Tissue Disease | 93 | Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders | 504 |
| 59 | Major Depressive, Bipolar, and Paranoid Disorders | 155 | Major Depression, Moderate or Severe, without Psychosis | 369 |
| 169 | Vertebral Fractures without Spinal Cord Injury | 401 | Vertebral Fractures without Spinal Cord Injury | 339 |
| 10 | Lymphoma and Other Cancers | 21 | Lymphoma and Other Cancers | 337 |
| 18 | Diabetes with Chronic Complications | 37 | Diabetes with Chronic Complications | 308 |
| 55 | Substance Use Disorder, Moderate/Severe, or Substance Use with Complications | 137 | Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications | 281 |
| 72 | Spinal Cord Disorders/Injuries | 182 | Spinal Cord Disorders/Injuries | 249 |
| 12 | Breast, Prostate, and Other Cancers and Tumors | 23 | Prostate, Breast, and Other Cancers and Tumors | 220 |
| 161 | Chronic Ulcer of Skin, Except Pressure | 383 | Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle | 194 |
| 167 | Major Head Injury | 399 | Major Head Injury without Loss of Consciousness | 188 |
| 108 | Vascular Disease | 267 | Deep Vein Thrombosis and Pulmonary Embolism | 152 |
| 18 | Diabetes with Chronic Complications | 298 | Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage | 148 |
| 10 | Lymphoma and Other Cancers | 20 | Lung and Other Severe Cancers | 147 |
| 106 | Atherosclerosis of the Extremities with Ulceration or Gangrene | 263 | Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene | 127 |
| 104 | Monoplegia, Other Paralytic Syndromes | 254 | Monoplegia, Other Paralytic Syndromes | 119 |
| 173 | Traumatic Amputations and Complications | 405 | Traumatic Amputations and Complications | 108 |
| 122 | Proliferative Diabetic Retinopathy and Vitreous Hemorrhage | 298 | Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage | 104 |
| 54 | Substance Use with Psychotic Complications | 135 | Drug Use with Psychotic Complications | 97 |
Where codes lost their payment HCC
2,252 codes left payment risk adjustment. 5 V24 categories lost every code (HCC 21, HCC 88, HCC 134, HCC 135, HCC 176). The table ranks V24 categories by codes that no longer count, with the V24 community, non-dual, aged factor they used to carry.
| V24 HCC | V24 category | Codes lost | V24 codes | V24 factor (CNA) |
|---|---|---|---|---|
| 59 | Major Depressive, Bipolar, and Paranoid Disorders | 427 | 831 | 0.309 |
| 176 | Complications of Specified Implanted Device or Graft | 325 | 325 | 0.582 |
| 167 | Major Head Injury | 251 | 496 | 0.077 |
| 189 | Amputation Status, Lower Limb/Amputation Complications | 250 | 291 | 0.519 |
| 23 | Other Significant Endocrine and Metabolic Disorders | 188 | 242 | 0.194 |
| 108 | Vascular Disease | 139 | 327 | 0.288 |
| 72 | Spinal Cord Disorders/Injuries | 90 | 354 | 0.481 |
| 18 | Diabetes with Chronic Complications | 80 | 400 | 0.302 |
| 40 | Rheumatoid Arthritis and Inflammatory Connective Tissue Disease | 71 | 648 | 0.421 |
| 134 | Dialysis Status | 52 | 52 | 0.435 |
| 39 | Bone/Joint/Muscle Infections/Necrosis | 44 | 652 | 0.401 |
| 48 | Coagulation Defects and Other Specified Hematological Disorders | 39 | 72 | 0.192 |
| 88 | Angina Pectoris | 37 | 37 | 0.135 |
| 47 | Disorders of Immunity | 34 | 72 | 0.665 |
| 173 | Traumatic Amputations and Complications | 34 | 145 | 0.208 |
| 107 | Vascular Disease with Complications | 33 | 145 | 0.383 |
| 115 | Pneumococcal Pneumonia, Empyema, Lung Abscess | 25 | 32 | 0.130 |
| 122 | Proliferative Diabetic Retinopathy and Vitreous Hemorrhage | 24 | 128 | 0.222 |
| 52 | Dementia Without Complication | 22 | 61 | 0.346 |
| 55 | Substance Use Disorder, Moderate/Severe, or Substance Use with Complications | 20 | 328 | 0.329 |
Where codes gained a payment HCC
228 codes count for payment only under V28. They concentrate in the categories below.
| V28 HCC | V28 category | New to payment | V28 codes | V28 factor (CNA) |
|---|---|---|---|---|
| 137 | Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications | 26 | 307 | 0.424 |
| 298 | Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage | 24 | 180 | 0.336 |
| 22 | Bladder, Colorectal, and Other Cancers | 22 | 126 | 0.363 |
| 153 | Personality Disorders; Anorexia/Bulimia Nervosa | 22 | 38 | 0.396 |
| 78 | Intestinal Obstruction/Perforation | 20 | 76 | 0.326 |
| 248 | Intracranial Hemorrhage | 20 | 53 | 0.239 |
| 213 | Cardio-Respiratory Failure and Shock | 15 | 36 | 0.370 |
| 202 | Coma, Brain Compression/Anoxic Damage | 14 | 61 | 0.543 |
| 387 | Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders | 14 | 14 | 0.406 |
| 109 | Acquired Hemolytic, Aplastic, and Sideroblastic Anemias | 8 | 37 | 1.144 |
| 65 | Chronic Hepatitis | 6 | 17 | 0.185 |
| 68 | Cholangitis and Obstruction of Bile Duct Without Gallstones | 6 | 8 | 0.388 |
| 50 | Amyloidosis, Porphyria, and Other Specified Metabolic Disorders | 4 | 29 | 0.648 |
| 223 | Heart Failure with Heart Assist Device/Artificial Heart | 4 | 6 | 2.505 |
| 17 | Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic | 3 | 79 | 4.209 |
| 93 | Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders | 3 | 507 | 0.617 |
| 192 | Cerebral Palsy, Except Quadriplegic | 3 | 9 | 0.314 |
| 279 | Severe Persistent Asthma | 3 | 3 | 0.818 |
| 409 | Amputation Status, Lower Limb/Amputation Complications | 3 | 44 | 0.598 |
| 182 | Spinal Cord Disorders/Injuries | 2 | 251 | 0.478 |
Every V24 category and where its codes went
For each V24 category: its factor, its code count in the PY2025 mapping, how many of those codes map to no V28 category, and the V28 categories that received the rest (largest first).
| V24 HCC | V24 category | Factor (CNA) | Codes | No V28 | V28 destinations (codes) |
|---|---|---|---|---|---|
| 1 | HIV/AIDS | 0.335 | 3 | 0 | 1 (3) |
| 2 | Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock | 0.352 | 53 | 2 | 2 (51), 6 (1) |
| 6 | Opportunistic Infections | 0.424 | 37 | 0 | 6 (37), 2 (1) |
| 8 | Metastatic Cancer and Acute Leukemia | 2.659 | 82 | 0 | 17 (57), 18 (22), 22 (3) |
| 9 | Lung and Other Severe Cancers | 1.024 | 110 | 0 | 20 (90), 19 (14), 17 (3), 22 (3) |
| 10 | Lymphoma and Other Cancers | 0.675 | 595 | 0 | 21 (337), 20 (147), 19 (44), 22 (43), +3 more |
| 11 | Colorectal, Bladder, and Other Cancers | 0.307 | 133 | 0 | 21 (77), 22 (55), 20 (1) |
| 12 | Breast, Prostate, and Other Cancers and Tumors | 0.150 | 271 | 0 | 23 (220), 21 (47), 17 (4) |
| 17 | Diabetes with Acute Complications | 0.302 | 23 | 5 | 36 (18) |
| 18 | Diabetes with Chronic Complications | 0.302 | 400 | 80 | 37 (308), 298 (148), 38 (12), 383 (8), +1 more |
| 19 | Diabetes without Complication | 0.105 | 6 | 1 | 38 (5) |
| 21 | Protein-Calorie Malnutrition | 0.455 | 11 | 11 | |
| 22 | Morbid Obesity | 0.250 | 9 | 0 | 48 (9) |
| 23 | Other Significant Endocrine and Metabolic Disorders | 0.194 | 242 | 188 | 50 (25), 49 (13), 51 (11), 21 (3), +2 more |
| 27 | End-Stage Liver Disease | 0.882 | 15 | 2 | 63 (13) |
| 28 | Cirrhosis of Liver | 0.363 | 10 | 1 | 64 (5), 63 (2), 68 (2) |
| 29 | Chronic Hepatitis | 0.147 | 11 | 0 | 65 (11) |
| 33 | Intestinal Obstruction/Perforation | 0.219 | 56 | 0 | 78 (56), 81 (7), 80 (4) |
| 34 | Chronic Pancreatitis | 0.287 | 2 | 0 | 79 (2) |
| 35 | Inflammatory Bowel Disease | 0.308 | 77 | 0 | 81 (49), 80 (28), 78 (11) |
| 39 | Bone/Joint/Muscle Infections/Necrosis | 0.401 | 652 | 44 | 92 (608) |
| 40 | Rheumatoid Arthritis and Inflammatory Connective Tissue Disease | 0.421 | 648 | 71 | 93 (504), 94 (69), 280 (6), 112 (2), +1 more |
| 46 | Severe Hematological Disorders | 1.372 | 95 | 5 | 108 (36), 109 (25), 107 (14), 19 (12), +3 more |
| 47 | Disorders of Immunity | 0.665 | 72 | 34 | 114 (18), 115 (15), 454 (4), 109 (1) |
| 48 | Coagulation Defects and Other Specified Hematological Disorders | 0.192 | 72 | 39 | 112 (19), 21 (5), 108 (3), 109 (3), +2 more |
| 51 | Dementia With Complications | 0.346 | 67 | 0 | 127 (37), 125 (15), 126 (15) |
| 52 | Dementia Without Complication | 0.346 | 61 | 22 | 127 (28), 200 (5), 125 (3), 126 (3) |
| 54 | Substance Use with Psychotic Complications | 0.329 | 116 | 0 | 135 (97), 136 (19) |
| 55 | Substance Use Disorder, Moderate/Severe, or Substance Use with Complications | 0.329 | 328 | 20 | 137 (281), 139 (27) |
| 56 | Substance Use Disorder, Mild, Except Alcohol and Cannabis | 0.329 | 14 | 0 | 138 (14) |
| 57 | Schizophrenia | 0.524 | 12 | 0 | 151 (12) |
| 58 | Reactive and Unspecified Psychosis | 0.393 | 4 | 0 | 152 (4) |
| 59 | Major Depressive, Bipolar, and Paranoid Disorders | 0.309 | 831 | 427 | 155 (369), 154 (27), 152 (8) |
| 60 | Personality Disorders | 0.309 | 16 | 0 | 153 (16) |
| 70 | Quadriplegia | 1.242 | 33 | 0 | 180 (33) |
| 71 | Paraplegia | 1.068 | 18 | 0 | 181 (18) |
| 72 | Spinal Cord Disorders/Injuries | 0.481 | 354 | 90 | 182 (249), 200 (11), 190 (4) |
| 73 | Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease | 0.999 | 7 | 0 | 190 (7) |
| 74 | Cerebral Palsy | 0.339 | 7 | 0 | 192 (6), 191 (1) |
| 75 | Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy | 0.472 | 52 | 16 | 93 (24), 196 (9), 193 (2), 195 (1) |
| 76 | Muscular Dystrophy | 0.518 | 20 | 0 | 197 (20) |
| 77 | Multiple Sclerosis | 0.423 | 12 | 0 | 198 (12) |
| 78 | Parkinson's and Huntington's Diseases | 0.606 | 20 | 3 | 199 (16), 200 (1) |
| 79 | Seizure Disorders and Convulsions | 0.220 | 63 | 0 | 201 (63) |
| 80 | Coma, Brain Compression/Anoxic Damage | 0.486 | 51 | 5 | 202 (46) |
| 82 | Respirator Dependence/Tracheostomy Status | 1.000 | 12 | 0 | 211 (12) |
| 83 | Respiratory Arrest | 0.354 | 1 | 0 | 212 (1) |
| 84 | Cardio-Respiratory Failure and Shock | 0.282 | 27 | 6 | 213 (21) |
| 85 | Congestive Heart Failure | 0.331 | 63 | 1 | 226 (34), 227 (14), 225 (5), 267 (5), +3 more |
| 86 | Acute Myocardial Infarction | 0.195 | 22 | 0 | 228 (18), 229 (4) |
| 87 | Unstable Angina and Other Acute Ischemic Heart Disease | 0.195 | 21 | 0 | 229 (21) |
| 88 | Angina Pectoris | 0.135 | 37 | 37 | |
| 96 | Specified Heart Arrhythmias | 0.268 | 20 | 3 | 238 (17) |
| 99 | Intracranial Hemorrhage | 0.230 | 33 | 0 | 248 (33) |
| 100 | Ischemic or Unspecified Stroke | 0.230 | 99 | 4 | 249 (95) |
| 103 | Hemiplegia/Hemiparesis | 0.437 | 45 | 0 | 253 (45) |
| 104 | Monoplegia, Other Paralytic Syndromes | 0.331 | 119 | 0 | 254 (119) |
| 106 | Atherosclerosis of the Extremities with Ulceration or Gangrene | 1.488 | 128 | 1 | 263 (127), 383 (90), 37 (4) |
| 107 | Vascular Disease with Complications | 0.383 | 145 | 33 | 383 (58), 264 (41), 267 (13) |
| 108 | Vascular Disease | 0.288 | 327 | 139 | 267 (152), 264 (30), 37 (4), 94 (2) |
| 110 | Cystic Fibrosis | 0.510 | 5 | 0 | 277 (5) |
| 111 | Chronic Obstructive Pulmonary Disease | 0.335 | 17 | 0 | 280 (17) |
| 112 | Fibrosis of Lung and Other Chronic Lung Disorders | 0.219 | 81 | 16 | 280 (62), 93 (5), 278 (3), 94 (1) |
| 114 | Aspiration and Specified Bacterial Pneumonias | 0.517 | 15 | 0 | 282 (14), 211 (1) |
| 115 | Pneumococcal Pneumonia, Empyema, Lung Abscess | 0.130 | 32 | 25 | 283 (7) |
| 122 | Proliferative Diabetic Retinopathy and Vitreous Hemorrhage | 0.222 | 128 | 24 | 298 (104), 37 (96), 108 (4) |
| 124 | Exudative Macular Degeneration | 0.521 | 16 | 0 | 300 (16) |
| 134 | Dialysis Status | 0.435 | 52 | 52 | |
| 135 | Acute Renal Failure | 0.435 | 5 | 5 | |
| 136 | Chronic Kidney Disease, Stage 5 | 0.289 | 5 | 0 | 326 (5), 226 (1) |
| 137 | Chronic Kidney Disease, Severe (Stage 4) | 0.289 | 1 | 0 | 327 (1) |
| 138 | Chronic Kidney Disease, Moderate (Stage 3) | 0.069 | 3 | 0 | 329 (2), 328 (1) |
| 157 | Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone | 2.028 | 25 | 0 | 379 (25) |
| 158 | Pressure Ulcer of Skin with Full Thickness Skin Loss | 1.069 | 50 | 0 | 381 (50) |
| 159 | Pressure Ulcer of Skin with Partial Thickness Skin Loss | 0.656 | 25 | 0 | 382 (25) |
| 161 | Chronic Ulcer of Skin, Except Pressure | 0.515 | 292 | 2 | 383 (194), 380 (96), 263 (90), 37 (8) |
| 162 | Severe Skin Burn or Condition | 0.224 | 96 | 6 | 385 (90) |
| 166 | Severe Head Injury | 0.486 | 76 | 0 | 397 (76) |
| 167 | Major Head Injury | 0.077 | 496 | 251 | 399 (188), 398 (57) |
| 169 | Vertebral Fractures without Spinal Cord Injury | 0.476 | 339 | 0 | 401 (339) |
| 170 | Hip Fracture/Dislocation | 0.350 | 729 | 0 | 402 (729) |
| 173 | Traumatic Amputations and Complications | 0.208 | 145 | 34 | 405 (108), 267 (2), 2 (1) |
| 176 | Complications of Specified Implanted Device or Graft | 0.582 | 325 | 325 | |
| 186 | Major Organ Transplant or Replacement Status | 0.832 | 51 | 0 | 276 (17), 221 (15), 454 (10), 62 (7), +3 more |
| 188 | Artificial Openings for Feeding or Elimination | 0.534 | 41 | 0 | 463 (41) |
| 189 | Amputation Status, Lower Limb/Amputation Complications | 0.519 | 291 | 250 | 409 (41) |
Every V28 category and where its codes came from
For each V28 category: its current factor (PY2027 software), its code count in the PY2025 mapping, how many of those codes had no V24 payment category, and the V24 categories they came from.
| V28 HCC | V28 category | Factor (CNA) | Codes | New | V24 sources (codes) |
|---|---|---|---|---|---|
| 1 | HIV/AIDS | 0.301 | 3 | 0 | 1 (3) |
| 2 | Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock | 0.500 | 52 | 0 | 2 (51), 6 (1), 173 (1) |
| 6 | Opportunistic Infections | 0.381 | 37 | 0 | 6 (37), 2 (1) |
| 17 | Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic | 4.209 | 79 | 3 | 8 (57), 10 (11), 12 (4), 9 (3), +1 more |
| 18 | Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid | 2.341 | 26 | 0 | 8 (22), 10 (4) |
| 19 | Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers | 1.798 | 71 | 0 | 10 (44), 9 (14), 46 (12), 48 (1) |
| 20 | Lung and Other Severe Cancers | 1.136 | 238 | 0 | 10 (147), 9 (90), 11 (1) |
| 21 | Lymphoma and Other Cancers | 0.671 | 469 | 0 | 10 (337), 11 (77), 12 (47), 48 (5), +1 more |
| 22 | Bladder, Colorectal, and Other Cancers | 0.363 | 126 | 22 | 11 (55), 10 (43), 8 (3), 9 (3) |
| 23 | Prostate, Breast, and Other Cancers and Tumors | 0.186 | 231 | 0 | 12 (220), 10 (9), 48 (2) |
| 35 | Pancreas Transplant Status | 0.949 | 1 | 0 | 186 (1) |
| 36 | Diabetes with Severe Acute Complications | 0.166 | 18 | 0 | 17 (18) |
| 37 | Diabetes with Chronic Complications | 0.166 | 308 | 0 | 18 (308), 122 (96), 161 (8), 106 (4), +1 more |
| 38 | Diabetes with Glycemic, Unspecified, or No Complications | 0.166 | 17 | 0 | 18 (12), 19 (5) |
| 48 | Morbid Obesity | 0.186 | 9 | 0 | 22 (9) |
| 49 | Specified Lysosomal Storage Disorders | 9.256 | 13 | 0 | 23 (13) |
| 50 | Amyloidosis, Porphyria, and Other Specified Metabolic Disorders | 0.648 | 29 | 4 | 23 (25) |
| 51 | Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders | 0.510 | 11 | 0 | 23 (11) |
| 62 | Liver Transplant Status/Complications | 0.376 | 7 | 0 | 186 (7) |
| 63 | Chronic Liver Failure/End-Stage Liver Disorders | 0.962 | 14 | 0 | 27 (13), 28 (2) |
| 64 | Cirrhosis of Liver | 0.447 | 6 | 1 | 28 (5) |
| 65 | Chronic Hepatitis | 0.185 | 17 | 6 | 29 (11) |
| 68 | Cholangitis and Obstruction of Bile Duct Without Gallstones | 0.388 | 8 | 6 | 28 (2) |
| 77 | Intestine Transplant Status/Complications | 1.172 | 6 | 0 | 186 (6) |
| 78 | Intestinal Obstruction/Perforation | 0.326 | 76 | 20 | 33 (56), 35 (11) |
| 79 | Chronic Pancreatitis | 0.357 | 2 | 0 | 34 (2) |
| 80 | Crohn's Disease (Regional Enteritis) | 0.550 | 28 | 0 | 35 (28), 33 (4) |
| 81 | Ulcerative Colitis | 0.244 | 49 | 0 | 35 (49), 33 (7) |
| 92 | Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis | 0.479 | 609 | 1 | 39 (608) |
| 93 | Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders | 0.617 | 507 | 3 | 40 (504), 75 (24), 112 (5) |
| 94 | Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders | 0.268 | 71 | 0 | 40 (69), 108 (2), 112 (1) |
| 107 | Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero | 0.457 | 14 | 0 | 46 (14) |
| 108 | Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major | 0.146 | 39 | 0 | 46 (36), 122 (4), 48 (3) |
| 109 | Acquired Hemolytic, Aplastic, and Sideroblastic Anemias | 1.144 | 37 | 8 | 46 (25), 48 (3), 47 (1) |
| 111 | Hemophilia, Male | 4.639 | 2 | 0 | 46 (2) |
| 112 | Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions | 0.450 | 21 | 0 | 48 (19), 40 (2) |
| 114 | Common Variable and Combined Immunodeficiencies | 2.262 | 18 | 0 | 47 (18) |
| 115 | Specified Immunodeficiencies and White Blood Cell Disorders | 0.565 | 16 | 0 | 47 (15), 23 (1) |
| 125 | Dementia, Severe | 0.341 | 18 | 0 | 51 (15), 52 (3) |
| 126 | Dementia, Moderate | 0.341 | 18 | 0 | 51 (15), 52 (3) |
| 127 | Dementia, Mild or Unspecified | 0.341 | 65 | 0 | 51 (37), 52 (28) |
| 135 | Drug Use with Psychotic Complications | 0.424 | 97 | 0 | 54 (97) |
| 136 | Alcohol Use with Psychotic Complications | 0.424 | 19 | 0 | 54 (19) |
| 137 | Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications | 0.424 | 307 | 26 | 55 (281) |
| 138 | Drug Use Disorder, Mild, Uncomplicated, Except Cannabis | 0.423 | 14 | 0 | 56 (14) |
| 139 | Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications | 0.242 | 27 | 0 | 55 (27) |
| 151 | Schizophrenia | 0.511 | 12 | 0 | 57 (12) |
| 152 | Psychosis, Except Schizophrenia | 0.484 | 12 | 0 | 59 (8), 58 (4) |
| 153 | Personality Disorders; Anorexia/Bulimia Nervosa | 0.396 | 38 | 22 | 60 (16) |
| 154 | Bipolar Disorders without Psychosis | 0.351 | 27 | 0 | 59 (27) |
| 155 | Major Depression, Moderate or Severe, without Psychosis | 0.299 | 369 | 0 | 59 (369) |
| 180 | Quadriplegia | 1.125 | 33 | 0 | 70 (33) |
| 181 | Paraplegia | 0.942 | 18 | 0 | 71 (18) |
| 182 | Spinal Cord Disorders/Injuries | 0.478 | 251 | 2 | 72 (249) |
| 190 | Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease, Spinal Muscular Atrophy | 1.175 | 11 | 0 | 73 (7), 72 (4) |
| 191 | Quadriplegic Cerebral Palsy | 0.855 | 1 | 0 | 74 (1) |
| 192 | Cerebral Palsy, Except Quadriplegic | 0.314 | 9 | 3 | 74 (6) |
| 193 | Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy | 1.692 | 2 | 0 | 75 (2) |
| 195 | Myasthenia Gravis with (Acute) Exacerbation | 2.909 | 1 | 0 | 75 (1) |
| 196 | Myasthenia Gravis without (Acute) Exacerbation and Other Myoneural Disorders | 0.516 | 9 | 0 | 75 (9) |
| 197 | Muscular Dystrophy | 0.426 | 20 | 0 | 76 (20) |
| 198 | Multiple Sclerosis | 0.647 | 12 | 0 | 77 (12) |
| 199 | Parkinson and Other Degenerative Disease of Basal Ganglia | 0.615 | 16 | 0 | 78 (16) |
| 200 | Friedreich and Other Hereditary Ataxias; Huntington Disease | 0.279 | 17 | 0 | 72 (11), 52 (5), 78 (1) |
| 201 | Seizure Disorders and Convulsions | 0.245 | 64 | 1 | 79 (63) |
| 202 | Coma, Brain Compression/Anoxic Damage | 0.543 | 61 | 14 | 80 (46), 23 (1) |
| 211 | Respirator Dependence/Tracheostomy Status/Complications | 0.879 | 13 | 0 | 82 (12), 114 (1) |
| 212 | Respiratory Arrest | 0.370 | 2 | 1 | 83 (1) |
| 213 | Cardio-Respiratory Failure and Shock | 0.370 | 36 | 15 | 84 (21) |
| 221 | Heart Transplant Status/Complications | 1.053 | 15 | 0 | 186 (15) |
| 222 | End-Stage Heart Failure | 2.505 | 1 | 0 | 85 (1) |
| 223 | Heart Failure with Heart Assist Device/Artificial Heart | 2.505 | 6 | 4 | 186 (2) |
| 224 | Acute on Chronic Heart Failure | 0.360 | 3 | 0 | 85 (3) |
| 225 | Acute Heart Failure (Excludes Acute on Chronic) | 0.360 | 6 | 1 | 85 (5) |
| 226 | Heart Failure, Except End-Stage and Acute | 0.360 | 34 | 0 | 85 (34), 136 (1) |
| 227 | Cardiomyopathy/Myocarditis | 0.189 | 14 | 0 | 85 (14) |
| 228 | Acute Myocardial Infarction | 0.252 | 18 | 0 | 86 (18) |
| 229 | Unstable Angina and Other Acute Ischemic Heart Disease | 0.240 | 25 | 0 | 87 (21), 86 (4) |
| 238 | Specified Heart Arrhythmias | 0.299 | 17 | 0 | 96 (17) |
| 248 | Intracranial Hemorrhage | 0.239 | 53 | 20 | 99 (33) |
| 249 | Ischemic or Unspecified Stroke | 0.239 | 95 | 0 | 100 (95) |
| 253 | Hemiplegia/Hemiparesis | 0.387 | 45 | 0 | 103 (45) |
| 254 | Monoplegia, Other Paralytic Syndromes | 0.321 | 119 | 0 | 104 (119) |
| 263 | Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene | 1.118 | 127 | 0 | 106 (127), 161 (90), 18 (4) |
| 264 | Vascular Disease with Complications | 0.455 | 71 | 0 | 107 (41), 108 (30) |
| 267 | Deep Vein Thrombosis and Pulmonary Embolism | 0.294 | 167 | 0 | 108 (152), 107 (13), 85 (5), 173 (2) |
| 276 | Lung Transplant Status/Complications | 2.531 | 17 | 0 | 186 (17) |
| 277 | Cystic Fibrosis | 0.998 | 5 | 0 | 110 (5) |
| 278 | Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis | 0.818 | 4 | 0 | 112 (3), 40 (2) |
| 279 | Severe Persistent Asthma | 0.818 | 3 | 3 | |
| 280 | Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders | 0.319 | 79 | 0 | 112 (62), 111 (17), 40 (6) |
| 282 | Aspiration and Specified Bacterial Pneumonias | 0.440 | 14 | 0 | 114 (14) |
| 283 | Empyema, Lung Abscess | 0.204 | 7 | 0 | 115 (7) |
| 298 | Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage | 0.336 | 180 | 24 | 18 (148), 122 (104), 46 (4) |
| 300 | Exudative Macular Degeneration | 0.596 | 16 | 0 | 124 (16) |
| 326 | Chronic Kidney Disease, Stage 5 | 0.815 | 5 | 0 | 136 (5), 85 (1) |
| 327 | Chronic Kidney Disease, Severe (Stage 4) | 0.514 | 1 | 0 | 137 (1) |
| 328 | Chronic Kidney Disease, Moderate (Stage 3B) | 0.127 | 1 | 0 | 138 (1) |
| 329 | Chronic Kidney Disease, Moderate (Stage 3, Except 3B) | 0.127 | 2 | 0 | 138 (2) |
| 379 | Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone | 1.965 | 25 | 0 | 157 (25) |
| 380 | Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle | 1.078 | 96 | 0 | 161 (96) |
| 381 | Pressure Ulcer of Skin with Full Thickness Skin Loss | 1.075 | 50 | 0 | 158 (50) |
| 382 | Pressure Ulcer of Skin with Partial Thickness Skin Loss | 0.838 | 25 | 0 | 159 (25) |
| 383 | Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle | 0.646 | 252 | 0 | 161 (194), 106 (90), 107 (58), 18 (8) |
| 385 | Severe Skin Burn | 1.291 | 90 | 0 | 162 (90) |
| 387 | Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders | 0.406 | 14 | 14 | |
| 397 | Major Head Injury with Loss of Consciousness > 1 Hour | 0.199 | 76 | 0 | 166 (76) |
| 398 | Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified | 0.199 | 57 | 0 | 167 (57) |
| 399 | Major Head Injury without Loss of Consciousness | 0.199 | 189 | 1 | 167 (188) |
| 401 | Vertebral Fractures without Spinal Cord Injury | 0.522 | 339 | 0 | 169 (339) |
| 402 | Hip Fracture/Dislocation | 0.467 | 729 | 0 | 170 (729) |
| 405 | Traumatic Amputations and Complications | 0.598 | 108 | 0 | 173 (108) |
| 409 | Amputation Status, Lower Limb/Amputation Complications | 0.598 | 44 | 3 | 189 (41) |
| 454 | Stem Cell, Including Bone Marrow, Transplant Status/Complications | 1.068 | 14 | 0 | 186 (10), 47 (4) |
| 463 | Artificial Openings for Feeding or Elimination | 0.673 | 41 | 0 | 188 (41) |
Method and limits
Source: the CMS payment year 2025 midyear/final ICD-10-CM mapping (11,725 rows; a code that maps to two categories in one model appears on two rows), the V24 software V2425.86.P1 for V24 labels and factors, and the V28 software V2826.115.T2 for current V28 factors. Factors are the community, non-dual, aged segment; the category pages show all seven V28 segments. Codes created after FY2025 are not in this mapping and have no V24 history. A lost category does not mean the condition stopped mattering clinically or for quality reporting, only that it no longer adds to the Medicare Advantage risk score. The steps are on the reference methodology page; the data is public domain and may be reused with attribution to QuickIntell and a link to this page. Each V28 category page carries a “What changed from V24” block built from the same file.
Where QuickIntell fits after the V28 transition
Codes that lost their category under V28 no longer move the risk score, and codes that gained one need documentation that supports them. QuickScribe captures the encounter documentation, and QuickCode supports qualified coder review before diagnoses are submitted.
Frequently asked questions
How many ICD-10-CM codes lost an HCC under V28?
In the payment year 2025 mapping, which lists both models for the same 11,207 codes, 2,252 codes had a V24 payment HCC and no V28 payment HCC (22.7% of the 9,927 V24-mapped codes). 228 codes went the other way and gained a V28 category.
Is V28 HCC 37 the same as V24 HCC 18?
Largely. All 308 of the 308 codes that map to V28 HCC 37 (Diabetes with Chronic Complications) mapped to V24 HCC 18 (Diabetes with Chronic Complications), but V24 HCC 18 also held codes that now map elsewhere or nowhere: 80 of its codes have no V28 category.
When did V28 fully replace V24?
CMS phased the 2024 CMS-HCC model (V28) in over three payment years: 33% V28 and 67% of the 2020 model (V24) in 2024, 67% V28 and 33% V24 in 2025, and 100% V28 from 2026, as set out in the CY2024, CY2025 and CY2026 Rate Announcements. The PY2026 and PY2027 model software no longer includes a CMS-HCC V24 model.
Did anything change between the PY2026 and PY2027 V28 releases?
No. The PY2027 initial ICD-10-CM mapping file is byte-identical to the PY2026 midyear final mapping (11,865 rows), and the V28 relative factors in software V2826.115.T2 match V2826.115.T1 for every segment.
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 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…
- CMS-HCC V24 model software, payment year 2025: labels, hierarchies and relative factorsVersion CMS-HCC V24 software V2425.86.P1 (PY2025) · effective 2025-01-01 · file C2419P1M.csvSHA-256 04a4f03db0e0af1e…
- 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 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…
Disclaimer
Mappings and relative factors are reproduced from CMS risk adjustment files as an operational reference. Plan payment depends on the 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.