HCC 326: Chronic Kidney Disease, Stage 5 ICD-10-CM
CMS-HCC Category 326 (Chronic Kidney Disease, Stage 5) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.815 and 1.050 to a beneficiary's RAF score depending on the payment segment (0.815 for a community, non-dual, aged enrollee). 5 ICD-10-CM diagnosis codes map to HCC 326. 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 | 0.815 |
| Community, partial-benefit dual, aged | 0.965 |
| Community, full-benefit dual, aged | 0.985 |
| Community, non-dual, disabled | 0.927 |
| Community, partial-benefit dual, disabled | 1.050 |
| Community, full-benefit dual, disabled | 0.946 |
| Institutional | 0.958 |
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 326 in turn supersedes HCC 327 (Chronic Kidney Disease, Severe (Stage 4)), HCC 328 (Chronic Kidney Disease, Moderate (Stage 3B)), and HCC 329 (Chronic Kidney Disease, Moderate (Stage 3, Except 3B)).
ICD-10-CM Codes That Map to HCC 326 5 codes
- I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease from V24 HCC 136
- I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease from V24 HCC 136
- I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease from V24 HCC 85, HCC 136
- N18.5 Chronic kidney disease, stage 5 from V24 HCC 136
- N18.6 End stage renal disease from V24 HCC 136
Every code above carries the full HCC 326 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 326
What is HCC 326 in the CMS-HCC model?
HCC 326 is CMS-HCC Category 326 (Chronic Kidney Disease, Stage 5) in the V28 risk adjustment model. It covers 5 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 326?
For payment year 2026, HCC 326 adds 0.815 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.815 to 1.050 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.
