HCC 68: Cholangitis and Obstruction of Bile Duct Without Gallstones ICD-10-CM
CMS-HCC Category 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.085 and 0.391 to a beneficiary's RAF score depending on the payment segment (0.388 for a community, non-dual, aged enrollee). 8 ICD-10-CM diagnosis codes map to HCC 68. A more severe related category (HCC 62, HCC 63, and HCC 64) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.388 |
| Community, partial-benefit dual, aged | 0.391 |
| Community, full-benefit dual, aged | 0.085 |
| Community, non-dual, disabled | 0.383 |
| Community, partial-benefit dual, disabled | 0.270 |
| Community, full-benefit dual, disabled | 0.354 |
| Institutional | 0.090 |
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. In the hierarchy, HCC 62 (Liver Transplant Status/Complications), HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders), and HCC 64 (Cirrhosis of Liver) supersede HCC 68 when reported together.
ICD-10-CM Codes That Map to HCC 68 8 codes
- K74.3 Primary biliary cirrhosis from V24 HCC 28
- K74.5 Biliary cirrhosis, unspecified from V24 HCC 28
- K83.01 Primary sclerosing cholangitis new to V28
- K83.09 Other cholangitis new to V28
- K83.1 Obstruction of bile duct new to V28
- Q44.2 Atresia of bile ducts new to V28
- Q44.3 Congenital stenosis and stricture of bile ducts new to V28
- Q44.71 Alagille syndrome new to V28
Every code above carries the full HCC 68 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 68
What is HCC 68 in the CMS-HCC model?
HCC 68 is CMS-HCC Category 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones) in the V28 risk adjustment model. It covers 8 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 68?
For payment year 2026, HCC 68 adds 0.388 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.085 to 0.391 across the seven payment segments shown above.
Which categories supersede HCC 68?
HCC 62 (Liver Transplant Status/Complications), HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders), and HCC 64 (Cirrhosis of Liver) sit above HCC 68 in the hierarchy: when a beneficiary has diagnoses in both, only the more severe category is paid.
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.
