HCC 36: Diabetes with Severe Acute Complications ICD-10-CM
CMS-HCC Category 36 (Diabetes with Severe Acute Complications) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.166 and 0.280 to a beneficiary's RAF score depending on the payment segment (0.166 for a community, non-dual, aged enrollee). 18 ICD-10-CM diagnosis codes map to HCC 36. A more severe related category (HCC 35) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.166 |
| Community, partial-benefit dual, aged | 0.166 |
| Community, full-benefit dual, aged | 0.186 |
| Community, non-dual, disabled | 0.191 |
| Community, partial-benefit dual, disabled | 0.210 |
| Community, full-benefit dual, disabled | 0.235 |
| Institutional | 0.280 |
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 35 (Pancreas Transplant Status) supersedes HCC 36 when reported together. HCC 36 in turn supersedes HCC 37 (Diabetes with Chronic Complications) and HCC 38 (Diabetes with No, Glycemic, or Unspecified Complications).
ICD-10-CM Codes That Map to HCC 36 18 codes
- E08.00 Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) from V24 HCC 17
- E08.01 Diabetes mellitus due to underlying condition with hyperosmolarity with coma from V24 HCC 17
- E08.10 Diabetes mellitus due to underlying condition with ketoacidosis without coma from V24 HCC 17
- E08.11 Diabetes mellitus due to underlying condition with ketoacidosis with coma from V24 HCC 17
- E08.641 Diabetes mellitus due to underlying condition with hypoglycemia with coma from V24 HCC 17
- E10.10 Type 1 diabetes mellitus with ketoacidosis without coma from V24 HCC 17
- E10.11 Type 1 diabetes mellitus with ketoacidosis with coma from V24 HCC 17
- E10.641 Type 1 diabetes mellitus with hypoglycemia with coma from V24 HCC 17
- E11.00 Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) from V24 HCC 17
- E11.01 Type 2 diabetes mellitus with hyperosmolarity with coma from V24 HCC 17
- E11.10 Type 2 diabetes mellitus with ketoacidosis without coma from V24 HCC 17
- E11.11 Type 2 diabetes mellitus with ketoacidosis with coma from V24 HCC 17
- E11.641 Type 2 diabetes mellitus with hypoglycemia with coma from V24 HCC 17
- E13.00 Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) from V24 HCC 17
- E13.01 Other specified diabetes mellitus with hyperosmolarity with coma from V24 HCC 17
- E13.10 Other specified diabetes mellitus with ketoacidosis without coma from V24 HCC 17
- E13.11 Other specified diabetes mellitus with ketoacidosis with coma from V24 HCC 17
- E13.641 Other specified diabetes mellitus with hypoglycemia with coma from V24 HCC 17
Every code above carries the full HCC 36 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 36
What is HCC 36 in the CMS-HCC model?
HCC 36 is CMS-HCC Category 36 (Diabetes with Severe Acute Complications) in the V28 risk adjustment model. It covers 18 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 36?
For payment year 2026, HCC 36 adds 0.166 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.166 to 0.280 across the seven payment segments shown above.
Which categories supersede HCC 36?
HCC 35 (Pancreas Transplant Status) sits above HCC 36 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.
