CMS-HCC Category |
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The table below contains a crosswalk of the ICD-10-CM codes that are included in the CMS-HCC Model (V21 - 2017, V22 - 2018, V23 - 2019, V24 - 2020, 2021, 2022, & 2023, V28 - 2024). It includes the HCC category descriptions, along with the associated disease hierarchy.
| HCC Category Description | Disease Hierarchy | ICD-10-CM Codes | |
|---|---|---|---|
| 1 | HIV/AIDS | ... | |
| 2 | Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock | ... | |
| 6 | Opportunistic Infections | ... | |
| 17 | Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic | 18, 19, 20, 21, 22, 23 | ... |
| 18 | Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid | 19, 20, 21, 22, 23 | ... |
| 19 | Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers | 20, 21, 22, 23 | ... |
| 20 | Lung and Other Severe Cancers | 21, 22, 23 | ... |
| 21 | Lymphoma and Other Cancers | 22, 23 | ... |
| 22 | Bladder, Colorectal, and Other Cancers | 23 | ... |
| 23 | Prostate, Breast, and Other Cancers and Tumors | ... | |
| 35 | Pancreas Transplant Status | 36, 37, 38 | ... |
| 36 | Diabetes with Severe Acute Complications | 37, 38 | ... |
| 37 | Diabetes with Chronic Complications | 38 | ... |
| 38 | Diabetes with Glycemic, Unspecified, or No Complications | ... | |
| 48 | Morbid Obesity | ... | |
| 49 | Specified Lysosomal Storage Disorders | ... | |
| 50 | Amyloidosis, Porphyria, and Other Specified Metabolic Disorders | ... | |
| 51 | Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders | ... | |
| 62 | Liver Transplant Status/Complications | 63, 64, 65, 68 | ... |
| 63 | Chronic Liver Failure/End-Stage Liver Disorders | 64, 65, 68, 202 | ... |
| 64 | Cirrhosis of Liver | 65, 68 | ... |
| 65 | Chronic Hepatitis | ... | |
| 68 | Cholangitis and Obstruction of Bile Duct Without Gallstones | ... | |
| 77 | Intestine Transplant Status/Complications | 78, 80, 81 | ... |
| 78 | Intestinal Obstruction/Perforation | ... | |
| 79 | Chronic Pancreatitis | ... | |
| 80 | Crohn's Disease (Regional Enteritis) | 81 | ... |
| 81 | Ulcerative Colitis | ... | |
| 92 | Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis | ... | |
| 93 | Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders | 94 | ... |
| 94 | Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders | ... | |
| 107 | Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero | 108 | ... |
| 108 | Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major | ... | |
| 109 | Acquired Hemolytic, Aplastic, and Sideroblastic Anemias | ... | |
| 111 | Hemophilia, Male | 112 | ... |
| 112 | Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions | ... | |
| 114 | Common Variable and Combined Immunodeficiencies | 115 | ... |
| 115 | Specified Immunodeficiencies and White Blood Cell Disorders | ... | |
| 125 | Dementia, Severe | 126, 127 | ... |
| 126 | Dementia, Moderate | 127 | ... |
| 127 | Dementia, Mild or Unspecified | ... | |
| 135 | Drug Use with Psychotic Complications | 136, 137, 138, 139 | ... |
| 136 | Alcohol Use with Psychotic Complications | 137, 138, 139 | ... |
| 137 | Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications | 138, 139 | ... |
| 138 | Drug Use Disorder, Mild, Uncomplicated, Except Cannabis | 139 | ... |
| 139 | Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications | ... | |
| 151 | Schizophrenia | 152, 153, 154, 155 | ... |
| 152 | Psychosis, Except Schizophrenia | 153, 154, 155 | ... |
| 153 | Personality Disorders; Anorexia/Bulimia Nervosa | 154, 155 | ... |
| 154 | Bipolar Disorders without Psychosis | 155 | ... |
| 155 | Major Depression, Moderate or Severe, without Psychosis | ... | |
| 180 | Quadriplegia | 181, 182, 253, 254 | ... |
| 181 | Paraplegia | 182, 254 | ... |
| 182 | Spinal Cord Disorders/Injuries | ... | |
| 190 | Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease, Spinal Muscular Atrophy | ... | |
| 191 | Quadriplegic Cerebral Palsy | 180, 181, 182, 192, 253, 254 | ... |
| 192 | Cerebral Palsy, Except Quadriplegic | 180, 181, 182, 253, 254 | ... |
| 193 | Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy | ... | |
| 195 | Myasthenia Gravis with (Acute) Exacerbation | 196 | ... |
| 196 | Myasthenia Gravis without (Acute) Exacerbation and Other Myoneural Disorders | ... | |
| 197 | Muscular Dystrophy | ... | |
| 198 | Multiple Sclerosis | ... | |
| 199 | Parkinson and Other Degenerative Disease of Basal Ganglia | ... | |
| 200 | Friedreich and Other Hereditary Ataxias; Huntington Disease | ... | |
| 201 | Seizure Disorders and Convulsions | ... | |
| 202 | Coma, Brain Compression/Anoxic Damage | ... | |
| 211 | Respirator Dependence/Tracheostomy Status/Complications | 212, 213 | ... |
| 212 | Respiratory Arrest | 213 | ... |
| 213 | Cardio-Respiratory Failure and Shock | ... | |
| 221 | Heart Transplant Status/Complications | 222, 223, 224, 225, 226, 227 | ... |
| 222 | End-Stage Heart Failure | 223, 224, 225, 226, 227 | ... |
| 223 | Heart Failure with Heart Assist Device/Artificial Heart | 224, 225, 226, 227 | ... |
| 224 | Acute on Chronic Heart Failure | 225, 226, 227 | ... |
| 225 | Acute Heart Failure (Excludes Acute on Chronic) | 226, 227 | ... |
| 226 | Heart Failure, Except End-Stage and Acute | 227 | ... |
| 227 | Cardiomyopathy/Myocarditis | ... | |
| 228 | Acute Myocardial Infarction | 229 | ... |
| 229 | Unstable Angina and Other Acute Ischemic Heart Disease | ... | |
| 238 | Specified Heart Arrhythmias | ... | |
| 248 | Intracranial Hemorrhage | 249 | ... |
| 249 | Ischemic or Unspecified Stroke | ... | |
| 253 | Hemiplegia/Hemiparesis | 254 | ... |
| 254 | Monoplegia, Other Paralytic Syndromes | ... | |
| 263 | Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene | 264, 383, 409 | ... |
| 264 | Vascular Disease with Complications | ... | |
| 267 | Deep Vein Thrombosis and Pulmonary Embolism | ... | |
| 276 | Lung Transplant Status/Complications | 277, 278, 279, 280 | ... |
| 277 | Cystic Fibrosis | 278, 279, 280 | ... |
| 278 | Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis | 279, 280 | ... |
| 279 | Severe Persistent Asthma | 280 | ... |
| 280 | Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders | ... | |
| 282 | Aspiration and Specified Bacterial Pneumonias | 283 | ... |
| 283 | Empyema, Lung Abscess | ... | |
| 298 | Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage | ... | |
| 300 | Exudative Macular Degeneration | ... | |
| 326 | Chronic Kidney Disease, Stage 5 | 327, 328, 329 | ... |
| 327 | Chronic Kidney Disease, Severe (Stage 4) | 328, 329 | ... |
| 328 | Chronic Kidney Disease, Moderate (Stage 3B) | 329 | ... |
| 329 | Chronic Kidney Disease, Moderate (Stage 3, Except 3B) | ... | |
| 379 | Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone | 380, 381, 382, 383 | ... |
| 380 | Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle | 381, 382, 383 | ... |
| 381 | Pressure Ulcer of Skin with Full Thickness Skin Loss | 382, 383 | ... |
| 382 | Pressure Ulcer of Skin with Partial Thickness Skin Loss | 383 | ... |
| 383 | Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle | ... | |
| 385 | Severe Skin Burn | ... | |
| 387 | Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders | ... | |
| 397 | Major Head Injury with Loss of Consciousness > 1 Hour | 202, 398, 399 | ... |
| 398 | Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified | 202, 399 | ... |
| 399 | Major Head Injury without Loss of Consciousness | ... | |
| 401 | Vertebral Fractures without Spinal Cord Injury | ... | |
| 402 | Hip Fracture/Dislocation | ... | |
| 405 | Traumatic Amputations and Complications | 409 | ... |
| 409 | Amputation Status, Lower Limb/Amputation Complications | ... | |
| 454 | Stem Cell, Including Bone Marrow, Transplant Status/Complications | ... | |
| 463 | Artificial Openings for Feeding or Elimination | ... |
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