HCC 181: Paraplegia ICD-10-CM
CMS-HCC Category 181 (Paraplegia) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.563 and 0.942 to a beneficiary's RAF score depending on the payment segment (0.942 for a community, non-dual, aged enrollee). 18 ICD-10-CM diagnosis codes map to HCC 181. A more severe related category (HCC 180, HCC 191, and HCC 192) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.942 |
| Community, partial-benefit dual, aged | 0.883 |
| Community, full-benefit dual, aged | 0.859 |
| Community, non-dual, disabled | 0.648 |
| Community, partial-benefit dual, disabled | 0.852 |
| Community, full-benefit dual, disabled | 0.832 |
| Institutional | 0.563 |
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 180 (Quadriplegia), HCC 191 (Quadriplegic Cerebral Palsy), and HCC 192 (Cerebral Palsy, Except Quadriplegic) supersede HCC 181 when reported together. HCC 181 in turn supersedes HCC 182 (Spinal Cord Disorders/Injuries) and HCC 254 (Monoplegia, Other Paralytic Syndromes).
ICD-10-CM Codes That Map to HCC 181 18 codes
- G82.20 Paraplegia, unspecified from V24 HCC 71
- G82.21 Paraplegia, complete from V24 HCC 71
- G82.22 Paraplegia, incomplete from V24 HCC 71
- S24.111A Complete lesion at T1 level of thoracic spinal cord, initial encounter from V24 HCC 71
- S24.111D Complete lesion at T1 level of thoracic spinal cord, subsequent encounter from V24 HCC 71
- S24.111S Complete lesion at T1 level of thoracic spinal cord, sequela from V24 HCC 71
- S24.112A Complete lesion at T2-T6 level of thoracic spinal cord, initial encounter from V24 HCC 71
- S24.112D Complete lesion at T2-T6 level of thoracic spinal cord, subsequent encounter from V24 HCC 71
- S24.112S Complete lesion at T2-T6 level of thoracic spinal cord, sequela from V24 HCC 71
- S24.113A Complete lesion at T7-T10 level of thoracic spinal cord, initial encounter from V24 HCC 71
- S24.113D Complete lesion at T7-T10 level of thoracic spinal cord, subsequent encounter from V24 HCC 71
- S24.113S Complete lesion at T7-T10 level of thoracic spinal cord, sequela from V24 HCC 71
- S24.114A Complete lesion at T11-T12 level of thoracic spinal cord, initial encounter from V24 HCC 71
- S24.114D Complete lesion at T11-T12 level of thoracic spinal cord, subsequent encounter from V24 HCC 71
- S24.114S Complete lesion at T11-T12 level of thoracic spinal cord, sequela from V24 HCC 71
- S24.119A Complete lesion at unspecified level of thoracic spinal cord, initial encounter from V24 HCC 71
- S24.119D Complete lesion at unspecified level of thoracic spinal cord, subsequent encounter from V24 HCC 71
- S24.119S Complete lesion at unspecified level of thoracic spinal cord, sequela from V24 HCC 71
Every code above carries the full HCC 181 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 181
What is HCC 181 in the CMS-HCC model?
HCC 181 is CMS-HCC Category 181 (Paraplegia) in the V28 risk adjustment model. It covers 18 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 181?
For payment year 2026, HCC 181 adds 0.942 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.563 to 0.942 across the seven payment segments shown above.
Which categories supersede HCC 181?
HCC 180 (Quadriplegia), HCC 191 (Quadriplegic Cerebral Palsy), and HCC 192 (Cerebral Palsy, Except Quadriplegic) sit above HCC 181 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.
