HCC 111: Hemophilia, Male ICD-10-CM
CMS-HCC Category 111 (Hemophilia, Male) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 4.639 and 32.199 to a beneficiary's RAF score depending on the payment segment (4.639 for a community, non-dual, aged enrollee). 2 ICD-10-CM diagnosis codes map to HCC 111. 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 | 4.639 |
| Community, partial-benefit dual, aged | 11.201 |
| Community, full-benefit dual, aged | 15.539 |
| Community, non-dual, disabled | 30.706 |
| Community, partial-benefit dual, disabled | 32.199 |
| Community, full-benefit dual, disabled | 31.424 |
| Institutional | 6.310 |
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 111 in turn supersedes HCC 112 (Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions).
ICD-10-CM Codes That Map to HCC 111 2 codes
- D66 Hereditary factor VIII deficiency from V24 HCC 46
- D67 Hereditary factor IX deficiency from V24 HCC 46
Every code above carries the full HCC 111 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 111
What is HCC 111 in the CMS-HCC model?
HCC 111 is CMS-HCC Category 111 (Hemophilia, Male) in the V28 risk adjustment model. It covers 2 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 111?
For payment year 2026, HCC 111 adds 4.639 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 4.639 to 32.199 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.
