HCC 35: Pancreas Transplant Status ICD-10-CM
CMS-HCC Category 35 (Pancreas Transplant Status) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.573 and 2.740 to a beneficiary's RAF score depending on the payment segment (0.949 for a community, non-dual, aged enrollee). 1 ICD-10-CM diagnosis codes map to HCC 35. 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 | 0.949 |
| Community, partial-benefit dual, aged | 1.117 |
| Community, full-benefit dual, aged | 1.117 |
| Community, non-dual, disabled | 1.393 |
| Community, partial-benefit dual, disabled | 2.740 |
| Community, full-benefit dual, disabled | 0.573 |
| Institutional | 1.106 |
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 35 in turn supersedes HCC 36 (Diabetes with Severe Acute Complications), HCC 37 (Diabetes with Chronic Complications), and HCC 38 (Diabetes with No, Glycemic, or Unspecified Complications).
ICD-10-CM Codes That Map to HCC 35 1 codes
- Z94.83 Pancreas transplant status from V24 HCC 186
Every code above carries the full HCC 35 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 35
What is HCC 35 in the CMS-HCC model?
HCC 35 is CMS-HCC Category 35 (Pancreas Transplant Status) in the V28 risk adjustment model. It covers 1 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 35?
For payment year 2026, HCC 35 adds 0.949 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.573 to 2.740 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.
