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 (living at home, age 65 or over, not also enrolled in Medicaid). 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.