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 HCC 6 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.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. 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.
