HCC 197: Muscular Dystrophy ICD-10-CM
CMS-HCC Category 197 (Muscular Dystrophy) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.145 and 0.681 to a beneficiary's RAF score depending on the payment segment (0.426 for a community, non-dual, aged enrollee). 21 ICD-10-CM diagnosis codes map to HCC 197. 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 | 0.426 |
| Community, partial-benefit dual, aged | 0.162 |
| Community, full-benefit dual, aged | 0.369 |
| Community, non-dual, disabled | 0.632 |
| Community, partial-benefit dual, disabled | 0.145 |
| Community, full-benefit dual, disabled | 0.681 |
| Institutional | 0.292 |
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 HCC 197 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.
ICD-10-CM Codes That Map to HCC 197 21 codes
- G71.00 Muscular dystrophy, unspecified from V24 HCC 76
- G71.01 Duchenne or Becker muscular dystrophy from V24 HCC 76
- G71.02 Facioscapulohumeral muscular dystrophy from V24 HCC 76
- G71.031 Autosomal dominant limb girdle muscular dystrophy from V24 HCC 76
- G71.032 Autosomal recessive limb girdle muscular dystrophy due to calpain-3 dysfunction from V24 HCC 76
- G71.033 Limb girdle muscular dystrophy due to dysferlin dysfunction from V24 HCC 76
- G71.0340 Limb girdle muscular dystrophy due to sarcoglycan dysfunction, unspecified from V24 HCC 76
- G71.0341 Limb girdle muscular dystrophy due to alpha sarcoglycan dysfunction from V24 HCC 76
- G71.0342 Limb girdle muscular dystrophy due to beta sarcoglycan dysfunction from V24 HCC 76
- G71.0349 Limb girdle muscular dystrophy due to other sarcoglycan dysfunction from V24 HCC 76
- G71.035 Limb girdle muscular dystrophy due to anoctamin-5 dysfunction from V24 HCC 76
- G71.036 Limb girdle muscular dystrophy due to fukutin related protein dysfunction new to V28
- G71.038 Other limb girdle muscular dystrophy from V24 HCC 76
- G71.039 Limb girdle muscular dystrophy, unspecified from V24 HCC 76
- G71.09 Other specified muscular dystrophies from V24 HCC 76
- G71.11 Myotonic muscular dystrophy from V24 HCC 76
- G71.20 Congenital myopathy, unspecified from V24 HCC 76
- G71.21 Nemaline myopathy from V24 HCC 76
- G71.220 X-linked myotubular myopathy from V24 HCC 76
- G71.228 Other centronuclear myopathy from V24 HCC 76
- G71.29 Other congenital myopathy from V24 HCC 76
Every code above carries the full HCC 197 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 197
What is HCC 197 in the CMS-HCC model?
HCC 197 is CMS-HCC Category 197 (Muscular Dystrophy) in the V28 risk adjustment model. It covers 21 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 197?
For payment year 2026, HCC 197 adds 0.426 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.145 to 0.681 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.
