CMS-HCC Risk Adjustment · V28 Model · Payment Year 2026 76 Codes

HCC 397: Major Head Injury with Loss of Consciousness > 1 Hour ICD-10-CM

CMS-HCC Category 397 (Major Head Injury with Loss of Consciousness > 1 Hour) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.052 and 0.349 to a beneficiary's RAF score depending on the payment segment (0.199 for a community, non-dual, aged enrollee). 76 ICD-10-CM diagnosis codes map to HCC 397. It sits at the top of its hierarchy: no other condition category supersedes it.

✓ Built from the official CMS PY 2026 risk adjustment filesV28 pays 100% of MA risk scores from PY 2026
+0.199
RAF, Community Non-Dual Aged
76
ICD-10-CM Codes
Top
Of Its Hierarchy
PY 2026
Dataset
CMS-HCC V28

RAF Weight by Payment Segment 7 segments

Payment SegmentRelative Factor
Community, non-dual, aged0.199
Community, partial-benefit dual, aged0.128
Community, full-benefit dual, aged0.349
Community, non-dual, disabled0.150
Community, partial-benefit dual, disabled0.052
Community, full-benefit dual, disabled0.190
Institutional0.085

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 397 in turn supersedes HCC 202 (Coma, Brain Compression/Anoxic Damage), HCC 398 (Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified), and HCC 399 (Major Head Injury without Loss of Consciousness).

ICD-10-CM

ICD-10-CM Codes That Map to HCC 397 76 codes

76 of 76 shown
  • S06.1X3A Traumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.1X4A Traumatic cerebral edema with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.1X5A Traumatic cerebral edema with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.1X6A Traumatic cerebral edema with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.2X3A Diffuse traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.2X4A Diffuse traumatic brain injury with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.2X5A Diffuse traumatic brain injury with loss of consciousness greater than 24 hours with return to pre-existing conscious levels, initial encounter from V24 HCC 166
  • S06.2X6A Diffuse traumatic brain injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.303A Unspecified focal traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.304A Unspecified focal traumatic brain injury with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.305A Unspecified focal traumatic brain injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.306A Unspecified focal traumatic brain injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.313A Contusion and laceration of right cerebrum with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.314A Contusion and laceration of right cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.315A Contusion and laceration of right cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.316A Contusion and laceration of right cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.323A Contusion and laceration of left cerebrum with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.324A Contusion and laceration of left cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.325A Contusion and laceration of left cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.326A Contusion and laceration of left cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.333A Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.334A Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.335A Contusion and laceration of cerebrum, unspecified, with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.336A Contusion and laceration of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.343A Traumatic hemorrhage of right cerebrum with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.344A Traumatic hemorrhage of right cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.345A Traumatic hemorrhage of right cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.346A Traumatic hemorrhage of right cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.353A Traumatic hemorrhage of left cerebrum with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.354A Traumatic hemorrhage of left cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.355A Traumatic hemorrhage of left cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.356A Traumatic hemorrhage of left cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.363A Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.364A Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.365A Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.366A Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.373A Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.374A Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.375A Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.376A Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.383A Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.384A Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.385A Contusion, laceration, and hemorrhage of brainstem with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.386A Contusion, laceration, and hemorrhage of brainstem with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.4X3A Epidural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.4X4A Epidural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.4X5A Epidural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.4X6A Epidural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.5X3A Traumatic subdural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.5X4A Traumatic subdural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.5X5A Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.5X6A Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.6X3A Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.6X4A Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.6X5A Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.6X6A Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.813A Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.814A Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.815A Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.816A Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.823A Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.824A Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.825A Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.826A Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.893A Other specified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.894A Other specified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.895A Other specified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.896A Other specified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.8A3A Primary blast injury of brain, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.8A4A Primary blast injury of brain, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.8A5A Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.8A6A Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166
  • S06.9X3A Unspecified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter from V24 HCC 166
  • S06.9X4A Unspecified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial encounter from V24 HCC 166
  • S06.9X5A Unspecified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter from V24 HCC 166
  • S06.9X6A Unspecified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter from V24 HCC 166

Every code above carries the full HCC 397 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 397

What is HCC 397 in the CMS-HCC model?

HCC 397 is CMS-HCC Category 397 (Major Head Injury with Loss of Consciousness > 1 Hour) in the V28 risk adjustment model. It covers 76 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.

What is the RAF weight for HCC 397?

For payment year 2026, HCC 397 adds 0.199 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.052 to 0.349 across the seven payment segments shown above.

Related References

All HCC CategoriesHCC 202 CodesHCC 398 CodesHCC 399 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.