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 HCC 109 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.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 (living at home, age 65 or over, not also enrolled in Medicaid). 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.
