HCC 463: Artificial Openings for Feeding or Elimination ICD-10-CM
CMS-HCC Category 463 (Artificial Openings for Feeding or Elimination) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.526 and 0.947 to a beneficiary's RAF score depending on the payment segment (0.673 for a community, non-dual, aged enrollee). 41 ICD-10-CM diagnosis codes map to HCC 463. It sits at the top of its hierarchy: no other condition category supersedes it.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.673 |
| Community, partial-benefit dual, aged | 0.526 |
| Community, full-benefit dual, aged | 0.891 |
| Community, non-dual, disabled | 0.914 |
| Community, partial-benefit dual, disabled | 0.853 |
| Community, full-benefit dual, disabled | 0.947 |
| Institutional | 0.634 |
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 HCC 463 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.
ICD-10-CM Codes That Map to HCC 463 41 codes
- K91.850 Pouchitis from V24 HCC 188
- K91.858 Other complications of intestinal pouch from V24 HCC 188
- K94.00 Colostomy complication, unspecified from V24 HCC 188
- K94.01 Colostomy hemorrhage from V24 HCC 188
- K94.02 Colostomy infection from V24 HCC 188
- K94.03 Colostomy malfunction from V24 HCC 188
- K94.09 Other complications of colostomy from V24 HCC 188
- K94.10 Enterostomy complication, unspecified from V24 HCC 188
- K94.11 Enterostomy hemorrhage from V24 HCC 188
- K94.12 Enterostomy infection from V24 HCC 188
- K94.13 Enterostomy malfunction from V24 HCC 188
- K94.19 Other complications of enterostomy from V24 HCC 188
- K94.20 Gastrostomy complication, unspecified from V24 HCC 188
- K94.21 Gastrostomy hemorrhage from V24 HCC 188
- K94.22 Gastrostomy infection from V24 HCC 188
- K94.23 Gastrostomy malfunction from V24 HCC 188
- K94.29 Other complications of gastrostomy from V24 HCC 188
- K94.30 Esophagostomy complications, unspecified from V24 HCC 188
- K94.31 Esophagostomy hemorrhage from V24 HCC 188
- K94.32 Esophagostomy infection from V24 HCC 188
- K94.33 Esophagostomy malfunction from V24 HCC 188
- K94.39 Other complications of esophagostomy from V24 HCC 188
- Z43.1 Encounter for attention to gastrostomy from V24 HCC 188
- Z43.2 Encounter for attention to ileostomy from V24 HCC 188
- Z43.3 Encounter for attention to colostomy from V24 HCC 188
- Z43.4 Encounter for attention to other artificial openings of digestive tract from V24 HCC 188
- Z43.5 Encounter for attention to cystostomy from V24 HCC 188
- Z43.6 Encounter for attention to other artificial openings of urinary tract from V24 HCC 188
- Z43.8 Encounter for attention to other artificial openings from V24 HCC 188
- Z43.9 Encounter for attention to unspecified artificial opening from V24 HCC 188
- Z93.1 Gastrostomy status from V24 HCC 188
- Z93.2 Ileostomy status from V24 HCC 188
- Z93.3 Colostomy status from V24 HCC 188
- Z93.4 Other artificial openings of gastrointestinal tract status from V24 HCC 188
- Z93.50 Unspecified cystostomy status from V24 HCC 188
- Z93.51 Cutaneous-vesicostomy status from V24 HCC 188
- Z93.52 Appendico-vesicostomy status from V24 HCC 188
- Z93.59 Other cystostomy status from V24 HCC 188
- Z93.6 Other artificial openings of urinary tract status from V24 HCC 188
- Z93.8 Other artificial opening status from V24 HCC 188
- Z93.9 Artificial opening status, unspecified from V24 HCC 188
Every code above carries the full HCC 463 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 463
What is HCC 463 in the CMS-HCC model?
HCC 463 is CMS-HCC Category 463 (Artificial Openings for Feeding or Elimination) in the V28 risk adjustment model. It covers 41 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 463?
For payment year 2026, HCC 463 adds 0.673 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 0.526 to 0.947 across the seven payment segments shown above.
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.
