HCC 48: Morbid Obesity ICD-10-CM
CMS-HCC Category 48 (Morbid Obesity) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.118 and 0.442 to a beneficiary's RAF score depending on the payment segment (0.186 for a community, non-dual, aged enrollee). 9 ICD-10-CM diagnosis codes map to HCC 48. 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 | 0.186 |
| Community, partial-benefit dual, aged | 0.164 |
| Community, full-benefit dual, aged | 0.300 |
| Community, non-dual, disabled | 0.144 |
| Community, partial-benefit dual, disabled | 0.118 |
| Community, full-benefit dual, disabled | 0.178 |
| Institutional | 0.442 |
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 HCC 48 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.
ICD-10-CM Codes That Map to HCC 48 9 codes
- E66.01 Morbid (severe) obesity due to excess calories from V24 HCC 22
- E66.2 Morbid (severe) obesity with alveolar hypoventilation from V24 HCC 22
- E66.813 Obesity, class 3 from V24 HCC 22
- Z68.41 Body mass index [BMI] 40.0-44.9, adult from V24 HCC 22
- Z68.42 Body mass index [BMI] 45.0-49.9, adult from V24 HCC 22
- Z68.43 Body mass index [BMI] 50.0-59.9, adult from V24 HCC 22
- Z68.44 Body mass index [BMI] 60.0-69.9, adult from V24 HCC 22
- Z68.45 Body mass index [BMI] 70 or greater, adult from V24 HCC 22
- Z68.56 Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age from V24 HCC 22
Every code above carries the full HCC 48 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 48
What is HCC 48 in the CMS-HCC model?
HCC 48 is CMS-HCC Category 48 (Morbid Obesity) in the V28 risk adjustment model. It covers 9 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 48?
For payment year 2026, HCC 48 adds 0.186 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.118 to 0.442 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.
