HCC 49: Specified Lysosomal Storage Disorders ICD-10-CM
CMS-HCC Category 49 (Specified Lysosomal Storage Disorders) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 1.528 and 13.778 to a beneficiary's RAF score depending on the payment segment (9.256 for a community, non-dual, aged enrollee). 13 ICD-10-CM diagnosis codes map to HCC 49. 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 | 9.256 |
| Community, partial-benefit dual, aged | 3.269 |
| Community, full-benefit dual, aged | 2.833 |
| Community, non-dual, disabled | 13.778 |
| Community, partial-benefit dual, disabled | 7.771 |
| Community, full-benefit dual, disabled | 6.399 |
| Institutional | 1.528 |
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 HCC 49 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.
ICD-10-CM Codes That Map to HCC 49 13 codes
- E74.02 Pompe disease from V24 HCC 23
- E75.21 Fabry (-Anderson) disease from V24 HCC 23
- E75.22 Gaucher disease from V24 HCC 23
- E76.01 Hurler's syndrome from V24 HCC 23
- E76.02 Hurler-Scheie syndrome from V24 HCC 23
- E76.03 Scheie's syndrome from V24 HCC 23
- E76.1 Mucopolysaccharidosis, type II from V24 HCC 23
- E76.210 Morquio A mucopolysaccharidoses from V24 HCC 23
- E76.211 Morquio B mucopolysaccharidoses from V24 HCC 23
- E76.219 Morquio mucopolysaccharidoses, unspecified from V24 HCC 23
- E76.22 Sanfilippo mucopolysaccharidoses from V24 HCC 23
- E76.29 Other mucopolysaccharidoses from V24 HCC 23
- E76.3 Mucopolysaccharidosis, unspecified from V24 HCC 23
Every code above carries the full HCC 49 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 49
What is HCC 49 in the CMS-HCC model?
HCC 49 is CMS-HCC Category 49 (Specified Lysosomal Storage Disorders) in the V28 risk adjustment model. It covers 13 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 49?
For payment year 2026, HCC 49 adds 9.256 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 1.528 to 13.778 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.
