HCC 115: Specified Immunodeficiencies and White Blood Cell Disorders ICD-10-CM
CMS-HCC Category 115 (Specified Immunodeficiencies and White Blood Cell Disorders) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.302 and 0.692 to a beneficiary's RAF score depending on the payment segment (0.565 for a community, non-dual, aged enrollee). 19 ICD-10-CM diagnosis codes map to HCC 115. A more severe related category (HCC 114) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.565 |
| Community, partial-benefit dual, aged | 0.302 |
| Community, full-benefit dual, aged | 0.438 |
| Community, non-dual, disabled | 0.692 |
| Community, partial-benefit dual, disabled | 0.613 |
| Community, full-benefit dual, disabled | 0.498 |
| Institutional | 0.691 |
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. In the hierarchy, HCC 114 (Common Variable and Combined Immunodeficiencies) supersedes HCC 115 when reported together.
ICD-10-CM Codes That Map to HCC 115 19 codes
- D70.0 Congenital agranulocytosis from V24 HCC 47
- D70.4 Cyclic neutropenia from V24 HCC 47
- D71 Functional disorders of polymorphonuclear neutrophils Non-billable from V24 HCC 47
- D71.1 Leukocyte adhesion deficiency new to V28
- D71.8 Other functional disorders of polymorphonuclear neutrophils new to V28
- D71.9 Functional disorders of polymorphonuclear neutrophils, unspecified new to V28
- D72.0 Genetic anomalies of leukocytes from V24 HCC 47
- D76.1 Hemophagocytic lymphohistiocytosis from V24 HCC 47
- D76.3 Other histiocytosis syndromes from V24 HCC 47
- D80.0 Hereditary hypogammaglobulinemia from V24 HCC 47
- D80.2 Selective deficiency of immunoglobulin A [IgA] from V24 HCC 47
- D80.3 Selective deficiency of immunoglobulin G [IgG] subclasses from V24 HCC 47
- D80.4 Selective deficiency of immunoglobulin M [IgM] from V24 HCC 47
- D80.5 Immunodeficiency with increased immunoglobulin M [IgM] from V24 HCC 47
- D81.4 Nezelof's syndrome from V24 HCC 47
- D82.0 Wiskott-Aldrich syndrome from V24 HCC 47
- D82.1 Di George's syndrome from V24 HCC 47
- D84.1 Defects in the complement system from V24 HCC 23
- D89.84 IgG4-related disease from V24 HCC 47
Every code above carries the full HCC 115 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 115
What is HCC 115 in the CMS-HCC model?
HCC 115 is CMS-HCC Category 115 (Specified Immunodeficiencies and White Blood Cell Disorders) in the V28 risk adjustment model. It covers 19 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 115?
For payment year 2026, HCC 115 adds 0.565 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.302 to 0.692 across the seven payment segments shown above.
Which categories supersede HCC 115?
HCC 114 (Common Variable and Combined Immunodeficiencies) sits above HCC 115 in the hierarchy: when a beneficiary has diagnoses in both, only the more severe category is paid.
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.
