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 HCC 2 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.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. 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.
