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 HCC 463 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.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. 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.
