HCC 1: HIV/AIDS ICD-10-CM
CMS-HCC Category 1 (HIV/AIDS) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.109 and 1.322 to a beneficiary's RAF score depending on the payment segment (0.301 for a community, non-dual, aged enrollee). 3 ICD-10-CM diagnosis codes map to HCC 1. It sits at the top of its hierarchy: no other condition category supersedes it.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.301 |
| Community, partial-benefit dual, aged | 0.196 |
| Community, full-benefit dual, aged | 0.397 |
| Community, non-dual, disabled | 0.213 |
| Community, partial-benefit dual, disabled | 0.109 |
| Community, full-benefit dual, disabled | 0.237 |
| Institutional | 1.322 |
A beneficiary is scored in exactly one segment, set by Medicaid (dual) status, aged or disabled entitlement, and residence. Factors are relative weights, not dollar amounts; new-enrollee segments score on demographics only. HCC 1 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.
ICD-10-CM Codes That Map to HCC 1 3 codes
- B20 Human immunodeficiency virus [HIV] disease
- B97.35 Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere
- Z21 Asymptomatic human immunodeficiency virus [HIV] infection status
Every code above carries the full HCC 1 weight when documented and reported on a Medicare Advantage encounter. The code link opens its full page with the complete risk adjustment card.
Questions About HCC 1
What is HCC 1 in the CMS-HCC model?
HCC 1 is CMS-HCC Category 1 (HIV/AIDS) in the V28 risk adjustment model. It covers 3 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 1?
For payment year 2026, HCC 1 adds 0.301 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.109 to 1.322 across the seven payment segments shown above.
Related References
Source: Centers for Medicare & Medicaid Services, Payment Year 2026 risk adjustment mapping and model software releases (CMS-HCC V28), applied to the FY 2026 ICD-10-CM code set. ICD List is not affiliated with CMS.
