HCC 6: Opportunistic Infections ICD-10-CM
CMS-HCC Category 6 (Opportunistic Infections) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.381 and 0.833 to a beneficiary's RAF score depending on the payment segment (0.381 for a community, non-dual, aged enrollee). 37 ICD-10-CM diagnosis codes map to HCC 6. 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 | 0.381 |
| Community, partial-benefit dual, aged | 0.518 |
| Community, full-benefit dual, aged | 0.588 |
| Community, non-dual, disabled | 0.763 |
| Community, partial-benefit dual, disabled | 0.685 |
| Community, full-benefit dual, disabled | 0.833 |
| Institutional | 0.728 |
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 HCC 6 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.
ICD-10-CM Codes That Map to HCC 6 37 codes
- A07.2 Cryptosporidiosis
- A31.0 Pulmonary mycobacterial infection
- A31.2 Disseminated mycobacterium avium-intracellulare complex (DMAC)
- B25.0 Cytomegaloviral pneumonitis
- B25.1 Cytomegaloviral hepatitis
- B25.2 Cytomegaloviral pancreatitis
- B25.8 Other cytomegaloviral diseases
- B25.9 Cytomegaloviral disease, unspecified
- B37.1 Pulmonary candidiasis
- B37.7 Candidal sepsis
- B37.81 Candidal esophagitis
- B44.0 Invasive pulmonary aspergillosis
- B44.1 Other pulmonary aspergillosis
- B44.2 Tonsillar aspergillosis
- B44.7 Disseminated aspergillosis
- B44.89 Other forms of aspergillosis
- B44.9 Aspergillosis, unspecified
- B45.0 Pulmonary cryptococcosis
- B45.1 Cerebral cryptococcosis
- B45.2 Cutaneous cryptococcosis
- B45.3 Osseous cryptococcosis
- B45.7 Disseminated cryptococcosis
- B45.8 Other forms of cryptococcosis
- B45.9 Cryptococcosis, unspecified
- B46.0 Pulmonary mucormycosis
- B46.1 Rhinocerebral mucormycosis
- B46.2 Gastrointestinal mucormycosis
- B46.3 Cutaneous mucormycosis
- B46.4 Disseminated mucormycosis
- B46.5 Mucormycosis, unspecified
- B46.8 Other zygomycoses
- B46.9 Zygomycosis, unspecified
- B48.4 Penicillosis
- B48.8 Other specified mycoses
- B58.2 Toxoplasma meningoencephalitis
- B58.3 Pulmonary toxoplasmosis
- B59 Pneumocystosis
Every code above carries the full HCC 6 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 6
What is HCC 6 in the CMS-HCC model?
HCC 6 is CMS-HCC Category 6 (Opportunistic Infections) in the V28 risk adjustment model. It covers 37 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 6?
For payment year 2026, HCC 6 adds 0.381 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 0.381 to 0.833 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.
