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 HCC 197 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.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 (living at home, age 65 or over, not also enrolled in Medicaid). 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.
