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. 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.
