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 (living at home, age 65 or over, not also enrolled in Medicaid). 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.
