HCC 202: Coma, Brain Compression/Anoxic Damage ICD-10-CM
CMS-HCC Category 202 (Coma, Brain Compression/Anoxic Damage) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.097 and 0.721 to a beneficiary's RAF score depending on the payment segment (0.543 for a community, non-dual, aged enrollee). 61 ICD-10-CM diagnosis codes map to HCC 202. A more severe related category (HCC 63, HCC 397, and HCC 398) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.543 |
| Community, partial-benefit dual, aged | 0.549 |
| Community, full-benefit dual, aged | 0.721 |
| Community, non-dual, disabled | 0.238 |
| Community, partial-benefit dual, disabled | 0.309 |
| Community, full-benefit dual, disabled | 0.279 |
| Institutional | 0.097 |
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 63 (Chronic Liver Failure/End-Stage Liver Disorders), HCC 397 (Major Head Injury with Loss of Consciousness > 1 Hour), and HCC 398 (Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified) supersede HCC 202 when reported together.
ICD-10-CM Codes That Map to HCC 202 61 codes
- E03.5 Myxedema coma from V24 HCC 23
- G93.1 Anoxic brain damage, not elsewhere classified from V24 HCC 80
- G93.5 Compression of brain from V24 HCC 80
- G93.6 Cerebral edema from V24 HCC 80
- P91.0 Neonatal cerebral ischemia new to V28
- P91.1 Acquired periventricular cysts of newborn new to V28
- P91.2 Neonatal cerebral leukomalacia new to V28
- P91.3 Neonatal cerebral irritability new to V28
- P91.4 Neonatal cerebral depression new to V28
- P91.5 Neonatal coma new to V28
- P91.60 Hypoxic ischemic encephalopathy [HIE], unspecified new to V28
- P91.61 Mild hypoxic ischemic encephalopathy [HIE] new to V28
- P91.62 Moderate hypoxic ischemic encephalopathy [HIE] new to V28
- P91.63 Severe hypoxic ischemic encephalopathy [HIE] new to V28
- P91.811 Neonatal encephalopathy in diseases classified elsewhere new to V28
- P91.819 Neonatal encephalopathy, unspecified new to V28
- P91.88 Other specified disturbances of cerebral status of newborn new to V28
- P91.9 Disturbance of cerebral status of newborn, unspecified new to V28
- R40.20 Unspecified coma from V24 HCC 80
- R40.2110 Coma scale, eyes open, never, unspecified time from V24 HCC 80
- R40.2111 Coma scale, eyes open, never, in the field [EMT or ambulance] from V24 HCC 80
- R40.2112 Coma scale, eyes open, never, at arrival to emergency department from V24 HCC 80
- R40.2113 Coma scale, eyes open, never, at hospital admission from V24 HCC 80
- R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission from V24 HCC 80
- R40.2120 Coma scale, eyes open, to pain, unspecified time from V24 HCC 80
- R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance] from V24 HCC 80
- R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department from V24 HCC 80
- R40.2123 Coma scale, eyes open, to pain, at hospital admission from V24 HCC 80
- R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission from V24 HCC 80
- R40.2210 Coma scale, best verbal response, none, unspecified time from V24 HCC 80
- R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance] from V24 HCC 80
- R40.2212 Coma scale, best verbal response, none, at arrival to emergency department from V24 HCC 80
- R40.2213 Coma scale, best verbal response, none, at hospital admission from V24 HCC 80
- R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission from V24 HCC 80
- R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time from V24 HCC 80
- R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance] from V24 HCC 80
- R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department from V24 HCC 80
- R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission from V24 HCC 80
- R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission from V24 HCC 80
- R40.2310 Coma scale, best motor response, none, unspecified time from V24 HCC 80
- R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance] from V24 HCC 80
- R40.2312 Coma scale, best motor response, none, at arrival to emergency department from V24 HCC 80
- R40.2313 Coma scale, best motor response, none, at hospital admission from V24 HCC 80
- R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission from V24 HCC 80
- R40.2320 Coma scale, best motor response, extension, unspecified time from V24 HCC 80
- R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance] from V24 HCC 80
- R40.2322 Coma scale, best motor response, extension, at arrival to emergency department from V24 HCC 80
- R40.2323 Coma scale, best motor response, extension, at hospital admission from V24 HCC 80
- R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission from V24 HCC 80
- R40.2430 Glasgow coma scale score 3-8, unspecified time from V24 HCC 80
- R40.2431 Glasgow coma scale score 3-8, in the field [EMT or ambulance] from V24 HCC 80
- R40.2432 Glasgow coma scale score 3-8, at arrival to emergency department from V24 HCC 80
- R40.2433 Glasgow coma scale score 3-8, at hospital admission from V24 HCC 80
- R40.2434 Glasgow coma scale score 3-8, 24 hours or more after hospital admission from V24 HCC 80
- R40.2440 Other coma, without documented Glasgow coma scale score, or with partial score reported, unspecified time from V24 HCC 80
- R40.2441 Other coma, without documented Glasgow coma scale score, or with partial score reported, in the field [EMT or ambulance] from V24 HCC 80
- R40.2442 Other coma, without documented Glasgow coma scale score, or with partial score reported, at arrival to emergency department from V24 HCC 80
- R40.2443 Other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission from V24 HCC 80
- R40.2444 Other coma, without documented Glasgow coma scale score, or with partial score reported, 24 hours or more after hospital admission from V24 HCC 80
- R40.2A Nontraumatic coma due to underlying condition from V24 HCC 80
- R40.3 Persistent vegetative state from V24 HCC 80
Every code above carries the full HCC 202 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 202
What is HCC 202 in the CMS-HCC model?
HCC 202 is CMS-HCC Category 202 (Coma, Brain Compression/Anoxic Damage) in the V28 risk adjustment model. It covers 61 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 202?
For payment year 2026, HCC 202 adds 0.543 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 0.097 to 0.721 across the seven payment segments shown above.
Which categories supersede HCC 202?
HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders), HCC 397 (Major Head Injury with Loss of Consciousness > 1 Hour), and HCC 398 (Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified) sit above HCC 202 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.
