HCC 109: Acquired Hemolytic, Aplastic, and Sideroblastic Anemias ICD-10-CM
CMS-HCC Category 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.529 and 1.815 to a beneficiary's RAF score depending on the payment segment (1.144 for a community, non-dual, aged enrollee). 37 ICD-10-CM diagnosis codes map to HCC 109. 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 | 1.144 |
| Community, partial-benefit dual, aged | 1.009 |
| Community, full-benefit dual, aged | 1.048 |
| Community, non-dual, disabled | 1.815 |
| Community, partial-benefit dual, disabled | 1.514 |
| Community, full-benefit dual, disabled | 1.541 |
| Institutional | 0.529 |
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 HCC 109 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.
ICD-10-CM Codes That Map to HCC 109 37 codes
- D59.10 Autoimmune hemolytic anemia, unspecified from V24 HCC 46
- D59.11 Warm autoimmune hemolytic anemia from V24 HCC 46
- D59.12 Cold autoimmune hemolytic anemia from V24 HCC 46
- D59.13 Mixed type autoimmune hemolytic anemia from V24 HCC 46
- D59.19 Other autoimmune hemolytic anemia from V24 HCC 46
- D59.30 Hemolytic-uremic syndrome, unspecified from V24 HCC 46
- D59.31 Infection-associated hemolytic-uremic syndrome from V24 HCC 46
- D59.32 Hereditary hemolytic-uremic syndrome from V24 HCC 46
- D59.39 Other hemolytic-uremic syndrome from V24 HCC 46
- D59.4 Other nonautoimmune hemolytic anemias from V24 HCC 46
- D59.5 Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli] from V24 HCC 46
- D59.6 Hemoglobinuria due to hemolysis from other external causes from V24 HCC 46
- D59.8 Other acquired hemolytic anemias from V24 HCC 46
- D59.9 Acquired hemolytic anemia, unspecified from V24 HCC 46
- D60.0 Chronic acquired pure red cell aplasia from V24 HCC 46
- D60.8 Other acquired pure red cell aplasias from V24 HCC 46
- D60.9 Acquired pure red cell aplasia, unspecified from V24 HCC 46
- D61.01 Constitutional (pure) red blood cell aplasia from V24 HCC 46
- D61.02 Shwachman-Diamond syndrome from V24 HCC 46
- D61.03 Fanconi anemia from V24 HCC 46
- D61.09 Other constitutional aplastic anemia from V24 HCC 46
- D61.2 Aplastic anemia due to other external agents from V24 HCC 46
- D61.3 Idiopathic aplastic anemia from V24 HCC 46
- D61.818 Other pancytopenia from V24 HCC 47
- D61.82 Myelophthisis from V24 HCC 46
- D61.89 Other specified aplastic anemias and other bone marrow failure syndromes from V24 HCC 46
- D64.0 Hereditary sideroblastic anemia from V24 HCC 48
- D64.1 Secondary sideroblastic anemia due to disease from V24 HCC 48
- D64.3 Other sideroblastic anemias from V24 HCC 48
- D64.4 Congenital dyserythropoietic anemia new to V28
- P55.0 Rh isoimmunization of newborn new to V28
- P55.1 ABO isoimmunization of newborn new to V28
- P55.8 Other hemolytic diseases of newborn new to V28
- P55.9 Hemolytic disease of newborn, unspecified new to V28
- P56.0 Hydrops fetalis due to isoimmunization new to V28
- P56.90 Hydrops fetalis due to unspecified hemolytic disease new to V28
- P56.99 Hydrops fetalis due to other hemolytic disease new to V28
Every code above carries the full HCC 109 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 109
What is HCC 109 in the CMS-HCC model?
HCC 109 is CMS-HCC Category 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias) in the V28 risk adjustment model. It covers 37 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 109?
For payment year 2026, HCC 109 adds 1.144 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.529 to 1.815 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.
