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 HCC 49 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.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. 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.
