HCC 2: Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock ICD-10-CM
CMS-HCC Category 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.447 and 0.780 to a beneficiary's RAF score depending on the payment segment (0.500 for a community, non-dual, aged enrollee). 52 ICD-10-CM diagnosis codes map to HCC 2. 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 | 0.500 |
| Community, partial-benefit dual, aged | 0.447 |
| Community, full-benefit dual, aged | 0.649 |
| Community, non-dual, disabled | 0.598 |
| Community, partial-benefit dual, disabled | 0.591 |
| Community, full-benefit dual, disabled | 0.780 |
| Institutional | 0.605 |
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 HCC 2 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.
ICD-10-CM Codes That Map to HCC 2 52 codes
- A02.1 Salmonella sepsis
- A20.7 Septicemic plague
- A22.7 Anthrax sepsis
- A26.7 Erysipelothrix sepsis
- A32.7 Listerial sepsis
- A39.2 Acute meningococcemia
- A39.3 Chronic meningococcemia
- A39.4 Meningococcemia, unspecified
- A40.0 Sepsis due to streptococcus, group A
- A40.1 Sepsis due to streptococcus, group B
- A40.3 Sepsis due to Streptococcus pneumoniae
- A40.8 Other streptococcal sepsis
- A40.9 Streptococcal sepsis, unspecified
- A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus
- A41.02 Sepsis due to Methicillin resistant Staphylococcus aureus
- A41.1 Sepsis due to other specified staphylococcus
- A41.2 Sepsis due to unspecified staphylococcus
- A41.3 Sepsis due to Hemophilus influenzae
- A41.4 Sepsis due to anaerobes
- A41.50 Gram-negative sepsis, unspecified
- A41.51 Sepsis due to Escherichia coli [E. coli]
- A41.52 Sepsis due to Pseudomonas
- A41.53 Sepsis due to Serratia
- A41.54 Sepsis due to Acinetobacter baumannii
- A41.59 Other Gram-negative sepsis
- A41.81 Sepsis due to Enterococcus
- A41.89 Other specified sepsis
- A41.9 Sepsis, unspecified organism
- A42.7 Actinomycotic sepsis
- A48.3 Toxic shock syndrome
- A54.86 Gonococcal sepsis
- B00.7 Disseminated herpesviral disease
- B37.7 Candidal sepsis
- M35.81 Multisystem inflammatory syndrome
- P02.70 Newborn affected by fetal inflammatory response syndrome
- P36.0 Sepsis of newborn due to streptococcus, group B
- P36.10 Sepsis of newborn due to unspecified streptococci
- P36.19 Sepsis of newborn due to other streptococci
- P36.2 Sepsis of newborn due to Staphylococcus aureus
- P36.30 Sepsis of newborn due to unspecified staphylococci
- P36.39 Sepsis of newborn due to other staphylococci
- P36.4 Sepsis of newborn due to Escherichia coli
- P36.5 Sepsis of newborn due to anaerobes
- P36.8 Other bacterial sepsis of newborn
- P36.9 Bacterial sepsis of newborn, unspecified
- R57.1 Hypovolemic shock
- R57.8 Other shock
- R65.10 Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction
- R65.11 Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction
- R65.20 Severe sepsis without septic shock
- R65.21 Severe sepsis with septic shock
- T79.4XXA Traumatic shock, initial encounter from V24 HCC 173
Every code above carries the full HCC 2 weight when documented and reported on a Medicare Advantage encounter. The code link opens its full page with the complete risk adjustment card.
V24 to V28 Changes for This Category
Under the retired CMS-HCC V24 model this category kept the same number (HCC 2). The V28 restructuring changed its membership:
Left in V28 T81.12XA Postprocedural septic shock, initial encounter no longer maps to any payment HCC.
Left in V28 T81.44XA Sepsis following a procedure, initial encounter no longer maps to any payment HCC.
Added in V28 T79.4XXA Traumatic shock, initial encounter moved from V24 HCC 173.
Questions About HCC 2
What is HCC 2 in the CMS-HCC model?
HCC 2 is CMS-HCC Category 2 (Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock) in the V28 risk adjustment model. It covers 52 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 2?
For payment year 2026, HCC 2 adds 0.500 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 0.447 to 0.780 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.
