HCC 38: Diabetes with No, Glycemic, or Unspecified Complications ICD-10-CM
CMS-HCC Category 38 (Diabetes with No, Glycemic, or Unspecified 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). 17 ICD-10-CM diagnosis codes map to HCC 38. A more severe related category (HCC 35, HCC 36, and HCC 37) 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), HCC 36 (Diabetes with Severe Acute Complications), and HCC 37 (Diabetes with Chronic Complications) supersede HCC 38 when reported together.
ICD-10-CM Codes That Map to HCC 38 17 codes
- E08.649 Diabetes mellitus due to underlying condition with hypoglycemia without coma from V24 HCC 18
- E08.65 Diabetes mellitus due to underlying condition with hyperglycemia from V24 HCC 18
- E08.8 Diabetes mellitus due to underlying condition with unspecified complications from V24 HCC 18
- E08.9 Diabetes mellitus due to underlying condition without complications from V24 HCC 19
- E10.649 Type 1 diabetes mellitus with hypoglycemia without coma from V24 HCC 18
- E10.65 Type 1 diabetes mellitus with hyperglycemia from V24 HCC 18
- E10.8 Type 1 diabetes mellitus with unspecified complications from V24 HCC 18
- E10.9 Type 1 diabetes mellitus without complications from V24 HCC 19
- E11.649 Type 2 diabetes mellitus with hypoglycemia without coma from V24 HCC 18
- E11.65 Type 2 diabetes mellitus with hyperglycemia from V24 HCC 18
- E11.8 Type 2 diabetes mellitus with unspecified complications from V24 HCC 18
- E11.9 Type 2 diabetes mellitus without complications from V24 HCC 19
- E13.649 Other specified diabetes mellitus with hypoglycemia without coma from V24 HCC 18
- E13.65 Other specified diabetes mellitus with hyperglycemia from V24 HCC 18
- E13.8 Other specified diabetes mellitus with unspecified complications from V24 HCC 18
- E13.9 Other specified diabetes mellitus without complications from V24 HCC 19
- Z79.4 Long term (current) use of insulin from V24 HCC 19
Every code above carries the full HCC 38 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 38
What is HCC 38 in the CMS-HCC model?
HCC 38 is CMS-HCC Category 38 (Diabetes with No, Glycemic, or Unspecified Complications) in the V28 risk adjustment model. It covers 17 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 38?
For payment year 2026, HCC 38 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 38?
HCC 35 (Pancreas Transplant Status), HCC 36 (Diabetes with Severe Acute Complications), and HCC 37 (Diabetes with Chronic Complications) sit above HCC 38 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.
