HCC 409: Amputation Status, Lower Limb/Amputation Complications ICD-10-CM
CMS-HCC Category 409 (Amputation Status, Lower Limb/Amputation Complications) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.284 and 0.844 to a beneficiary's RAF score depending on the payment segment (0.598 for a community, non-dual, aged enrollee). 44 ICD-10-CM diagnosis codes map to HCC 409. A more severe related category (HCC 263 and HCC 405) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.598 |
| Community, partial-benefit dual, aged | 0.604 |
| Community, full-benefit dual, aged | 0.799 |
| Community, non-dual, disabled | 0.562 |
| Community, partial-benefit dual, disabled | 0.623 |
| Community, full-benefit dual, disabled | 0.844 |
| Institutional | 0.284 |
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 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) and HCC 405 (Traumatic Amputations and Complications) supersede HCC 409 when reported together.
ICD-10-CM Codes That Map to HCC 409 44 codes
- G54.6 Phantom limb syndrome with pain from V24 HCC 189
- G54.7 Phantom limb syndrome without pain from V24 HCC 189
- T87.30 Neuroma of amputation stump, unspecified extremity from V24 HCC 189
- T87.31 Neuroma of amputation stump, right upper extremity from V24 HCC 189
- T87.32 Neuroma of amputation stump, left upper extremity from V24 HCC 189
- T87.33 Neuroma of amputation stump, right lower extremity from V24 HCC 189
- T87.34 Neuroma of amputation stump, left lower extremity from V24 HCC 189
- T87.40 Infection of amputation stump, unspecified extremity from V24 HCC 189
- T87.41 Infection of amputation stump, right upper extremity from V24 HCC 189
- T87.42 Infection of amputation stump, left upper extremity from V24 HCC 189
- T87.43 Infection of amputation stump, right lower extremity from V24 HCC 189
- T87.44 Infection of amputation stump, left lower extremity from V24 HCC 189
- T87.50 Necrosis of amputation stump, unspecified extremity from V24 HCC 189
- T87.51 Necrosis of amputation stump, right upper extremity from V24 HCC 189
- T87.52 Necrosis of amputation stump, left upper extremity from V24 HCC 189
- T87.53 Necrosis of amputation stump, right lower extremity from V24 HCC 189
- T87.54 Necrosis of amputation stump, left lower extremity from V24 HCC 189
- T87.81 Dehiscence of amputation stump from V24 HCC 189
- T87.89 Other complications of amputation stump from V24 HCC 189
- T87.9 Unspecified complications of amputation stump from V24 HCC 189
- Z44.101 Encounter for fitting and adjustment of unspecified right artificial leg from V24 HCC 189
- Z44.102 Encounter for fitting and adjustment of unspecified left artificial leg from V24 HCC 189
- Z44.109 Encounter for fitting and adjustment of unspecified artificial leg, unspecified leg from V24 HCC 189
- Z44.111 Encounter for fitting and adjustment of complete right artificial leg from V24 HCC 189
- Z44.112 Encounter for fitting and adjustment of complete left artificial leg from V24 HCC 189
- Z44.119 Encounter for fitting and adjustment of complete artificial leg, unspecified leg from V24 HCC 189
- Z44.121 Encounter for fitting and adjustment of partial artificial right leg from V24 HCC 189
- Z44.122 Encounter for fitting and adjustment of partial artificial left leg from V24 HCC 189
- Z44.129 Encounter for fitting and adjustment of partial artificial leg, unspecified leg from V24 HCC 189
- Z89.431 Acquired absence of right foot from V24 HCC 189
- Z89.432 Acquired absence of left foot from V24 HCC 189
- Z89.439 Acquired absence of unspecified foot from V24 HCC 189
- Z89.441 Acquired absence of right ankle from V24 HCC 189
- Z89.442 Acquired absence of left ankle from V24 HCC 189
- Z89.449 Acquired absence of unspecified ankle from V24 HCC 189
- Z89.511 Acquired absence of right leg below knee from V24 HCC 189
- Z89.512 Acquired absence of left leg below knee from V24 HCC 189
- Z89.519 Acquired absence of unspecified leg below knee from V24 HCC 189
- Z89.611 Acquired absence of right leg above knee from V24 HCC 189
- Z89.612 Acquired absence of left leg above knee from V24 HCC 189
- Z89.619 Acquired absence of unspecified leg above knee from V24 HCC 189
- Z97.13 Presence of artificial right leg (complete) (partial) new to V28
- Z97.14 Presence of artificial left leg (complete) (partial) new to V28
- Z97.16 Presence of artificial legs, bilateral (complete) (partial) new to V28
Every code above carries the full HCC 409 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 409
What is HCC 409 in the CMS-HCC model?
HCC 409 is CMS-HCC Category 409 (Amputation Status, Lower Limb/Amputation Complications) in the V28 risk adjustment model. It covers 44 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 409?
For payment year 2026, HCC 409 adds 0.598 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.284 to 0.844 across the seven payment segments shown above.
Which categories supersede HCC 409?
HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) and HCC 405 (Traumatic Amputations and Complications) sit above HCC 409 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.
