CMS-HCC Risk Adjustment · V28 Model · Payment Year 2026 50 Codes

HCC 381: Pressure Ulcer of Skin with Full Thickness Skin Loss ICD-10-CM

CMS-HCC Category 381 (Pressure Ulcer of Skin with Full Thickness Skin Loss) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.423 and 1.379 to a beneficiary's RAF score depending on the payment segment (1.075 for a community, non-dual, aged enrollee). 50 ICD-10-CM diagnosis codes map to HCC 381. A more severe related category (HCC 379 and HCC 380) supersedes it when both are reported.

✓ Built from the official CMS PY 2026 risk adjustment filesV28 pays 100% of MA risk scores from PY 2026
+1.075
RAF, Community Non-Dual Aged
50
ICD-10-CM Codes
HCC 379
Superseded By
PY 2026
Dataset
CMS-HCC V28

RAF Weight by Payment Segment 7 segments

Payment SegmentRelative Factor
Community, non-dual, aged1.075
Community, partial-benefit dual, aged1.136
Community, full-benefit dual, aged1.379
Community, non-dual, disabled1.091
Community, partial-benefit dual, disabled1.089
Community, full-benefit dual, disabled1.192
Institutional0.423

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 379 (Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone) and HCC 380 (Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle) supersede HCC 381 when reported together. HCC 381 in turn supersedes HCC 382 (Pressure Ulcer of Skin with Partial Thickness Skin Loss) and HCC 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle).

ICD-10-CM

ICD-10-CM Codes That Map to HCC 381 50 codes

50 of 50 shown
  • L89.000 Pressure ulcer of unspecified elbow, unstageable from V24 HCC 158
  • L89.003 Pressure ulcer of unspecified elbow, stage 3 from V24 HCC 158
  • L89.010 Pressure ulcer of right elbow, unstageable from V24 HCC 158
  • L89.013 Pressure ulcer of right elbow, stage 3 from V24 HCC 158
  • L89.020 Pressure ulcer of left elbow, unstageable from V24 HCC 158
  • L89.023 Pressure ulcer of left elbow, stage 3 from V24 HCC 158
  • L89.100 Pressure ulcer of unspecified part of back, unstageable from V24 HCC 158
  • L89.103 Pressure ulcer of unspecified part of back, stage 3 from V24 HCC 158
  • L89.110 Pressure ulcer of right upper back, unstageable from V24 HCC 158
  • L89.113 Pressure ulcer of right upper back, stage 3 from V24 HCC 158
  • L89.120 Pressure ulcer of left upper back, unstageable from V24 HCC 158
  • L89.123 Pressure ulcer of left upper back, stage 3 from V24 HCC 158
  • L89.130 Pressure ulcer of right lower back, unstageable from V24 HCC 158
  • L89.133 Pressure ulcer of right lower back, stage 3 from V24 HCC 158
  • L89.140 Pressure ulcer of left lower back, unstageable from V24 HCC 158
  • L89.143 Pressure ulcer of left lower back, stage 3 from V24 HCC 158
  • L89.150 Pressure ulcer of sacral region, unstageable from V24 HCC 158
  • L89.153 Pressure ulcer of sacral region, stage 3 from V24 HCC 158
  • L89.200 Pressure ulcer of unspecified hip, unstageable from V24 HCC 158
  • L89.203 Pressure ulcer of unspecified hip, stage 3 from V24 HCC 158
  • L89.210 Pressure ulcer of right hip, unstageable from V24 HCC 158
  • L89.213 Pressure ulcer of right hip, stage 3 from V24 HCC 158
  • L89.220 Pressure ulcer of left hip, unstageable from V24 HCC 158
  • L89.223 Pressure ulcer of left hip, stage 3 from V24 HCC 158
  • L89.300 Pressure ulcer of unspecified buttock, unstageable from V24 HCC 158
  • L89.303 Pressure ulcer of unspecified buttock, stage 3 from V24 HCC 158
  • L89.310 Pressure ulcer of right buttock, unstageable from V24 HCC 158
  • L89.313 Pressure ulcer of right buttock, stage 3 from V24 HCC 158
  • L89.320 Pressure ulcer of left buttock, unstageable from V24 HCC 158
  • L89.323 Pressure ulcer of left buttock, stage 3 from V24 HCC 158
  • L89.43 Pressure ulcer of contiguous site of back, buttock and hip, stage 3 from V24 HCC 158
  • L89.45 Pressure ulcer of contiguous site of back, buttock and hip, unstageable from V24 HCC 158
  • L89.500 Pressure ulcer of unspecified ankle, unstageable from V24 HCC 158
  • L89.503 Pressure ulcer of unspecified ankle, stage 3 from V24 HCC 158
  • L89.510 Pressure ulcer of right ankle, unstageable from V24 HCC 158
  • L89.513 Pressure ulcer of right ankle, stage 3 from V24 HCC 158
  • L89.520 Pressure ulcer of left ankle, unstageable from V24 HCC 158
  • L89.523 Pressure ulcer of left ankle, stage 3 from V24 HCC 158
  • L89.600 Pressure ulcer of unspecified heel, unstageable from V24 HCC 158
  • L89.603 Pressure ulcer of unspecified heel, stage 3 from V24 HCC 158
  • L89.610 Pressure ulcer of right heel, unstageable from V24 HCC 158
  • L89.613 Pressure ulcer of right heel, stage 3 from V24 HCC 158
  • L89.620 Pressure ulcer of left heel, unstageable from V24 HCC 158
  • L89.623 Pressure ulcer of left heel, stage 3 from V24 HCC 158
  • L89.810 Pressure ulcer of head, unstageable from V24 HCC 158
  • L89.813 Pressure ulcer of head, stage 3 from V24 HCC 158
  • L89.890 Pressure ulcer of other site, unstageable from V24 HCC 158
  • L89.893 Pressure ulcer of other site, stage 3 from V24 HCC 158
  • L89.93 Pressure ulcer of unspecified site, stage 3 from V24 HCC 158
  • L89.95 Pressure ulcer of unspecified site, unstageable from V24 HCC 158

Every code above carries the full HCC 381 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 381

What is HCC 381 in the CMS-HCC model?

HCC 381 is CMS-HCC Category 381 (Pressure Ulcer of Skin with Full Thickness Skin Loss) in the V28 risk adjustment model. It covers 50 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.

What is the RAF weight for HCC 381?

For payment year 2026, HCC 381 adds 1.075 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.423 to 1.379 across the seven payment segments shown above.

Which categories supersede HCC 381?

HCC 379 (Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone) and HCC 380 (Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle) sit above HCC 381 in the hierarchy: when a beneficiary has diagnoses in both, only the more severe category is paid.

Related References

All HCC CategoriesHCC 379 CodesHCC 380 CodesHCC 382 CodesHCC 383 CodesV24 to V28: What ChangedICD-10-CM Code Lookup

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.