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 HCC 48 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.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 (living at home, age 65 or over, not also enrolled in Medicaid). 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.
