HCC 196: Myasthenia Gravis without (Acute) Exacerbation and Other Myoneural Disorders ICD-10-CM
CMS-HCC Category 196 (Myasthenia Gravis without (Acute) Exacerbation and Other Myoneural Disorders) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.248 and 0.642 to a beneficiary's RAF score depending on the payment segment (0.516 for a community, non-dual, aged enrollee). 9 ICD-10-CM diagnosis codes map to HCC 196. A more severe related category (HCC 195) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.516 |
| Community, partial-benefit dual, aged | 0.427 |
| Community, full-benefit dual, aged | 0.503 |
| Community, non-dual, disabled | 0.642 |
| Community, partial-benefit dual, disabled | 0.248 |
| Community, full-benefit dual, disabled | 0.507 |
| Institutional | 0.486 |
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 195 (Myasthenia Gravis with (Acute) Exacerbation) supersedes HCC 196 when reported together.
ICD-10-CM Codes That Map to HCC 196 9 codes
- G70.00 Myasthenia gravis without (acute) exacerbation from V24 HCC 75
- G70.1 Toxic myoneural disorders from V24 HCC 75
- G70.2 Congenital and developmental myasthenia from V24 HCC 75
- G70.80 Lambert-Eaton syndrome, unspecified from V24 HCC 75
- G70.81 Lambert-Eaton syndrome in disease classified elsewhere from V24 HCC 75
- G70.89 Other specified myoneural disorders from V24 HCC 75
- G70.9 Myoneural disorder, unspecified from V24 HCC 75
- G73.1 Lambert-Eaton syndrome in neoplastic disease from V24 HCC 75
- G73.3 Myasthenic syndromes in other diseases classified elsewhere from V24 HCC 75
Every code above carries the full HCC 196 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 196
What is HCC 196 in the CMS-HCC model?
HCC 196 is CMS-HCC Category 196 (Myasthenia Gravis without (Acute) Exacerbation and Other Myoneural Disorders) in the V28 risk adjustment model. It covers 9 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 196?
For payment year 2026, HCC 196 adds 0.516 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.248 to 0.642 across the seven payment segments shown above.
Which categories supersede HCC 196?
HCC 195 (Myasthenia Gravis with (Acute) Exacerbation) sits above HCC 196 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.
