HCC 80: Crohn's Disease (Regional Enteritis) ICD-10-CM
CMS-HCC Category 80 (Crohn's Disease (Regional Enteritis)) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.374 and 0.651 to a beneficiary's RAF score depending on the payment segment (0.550 for a community, non-dual, aged enrollee). 28 ICD-10-CM diagnosis codes map to HCC 80. A more severe related category (HCC 77) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.550 |
| Community, partial-benefit dual, aged | 0.479 |
| Community, full-benefit dual, aged | 0.490 |
| Community, non-dual, disabled | 0.635 |
| Community, partial-benefit dual, disabled | 0.603 |
| Community, full-benefit dual, disabled | 0.651 |
| Institutional | 0.374 |
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 77 (Intestine Transplant Status/Complications) supersedes HCC 80 when reported together. HCC 80 in turn supersedes HCC 81 (Ulcerative Colitis).
ICD-10-CM Codes That Map to HCC 80 28 codes
- K50.00 Crohn's disease of small intestine without complications from V24 HCC 35
- K50.011 Crohn's disease of small intestine with rectal bleeding from V24 HCC 35
- K50.012 Crohn's disease of small intestine with intestinal obstruction from V24 HCC 33, HCC 35
- K50.013 Crohn's disease of small intestine with fistula from V24 HCC 35
- K50.014 Crohn's disease of small intestine with abscess from V24 HCC 35
- K50.018 Crohn's disease of small intestine with other complication from V24 HCC 35
- K50.019 Crohn's disease of small intestine with unspecified complications from V24 HCC 35
- K50.10 Crohn's disease of large intestine without complications from V24 HCC 35
- K50.111 Crohn's disease of large intestine with rectal bleeding from V24 HCC 35
- K50.112 Crohn's disease of large intestine with intestinal obstruction from V24 HCC 33, HCC 35
- K50.113 Crohn's disease of large intestine with fistula from V24 HCC 35
- K50.114 Crohn's disease of large intestine with abscess from V24 HCC 35
- K50.118 Crohn's disease of large intestine with other complication from V24 HCC 35
- K50.119 Crohn's disease of large intestine with unspecified complications from V24 HCC 35
- K50.80 Crohn's disease of both small and large intestine without complications from V24 HCC 35
- K50.811 Crohn's disease of both small and large intestine with rectal bleeding from V24 HCC 35
- K50.812 Crohn's disease of both small and large intestine with intestinal obstruction from V24 HCC 33, HCC 35
- K50.813 Crohn's disease of both small and large intestine with fistula from V24 HCC 35
- K50.814 Crohn's disease of both small and large intestine with abscess from V24 HCC 35
- K50.818 Crohn's disease of both small and large intestine with other complication from V24 HCC 35
- K50.819 Crohn's disease of both small and large intestine with unspecified complications from V24 HCC 35
- K50.90 Crohn's disease, unspecified, without complications from V24 HCC 35
- K50.911 Crohn's disease, unspecified, with rectal bleeding from V24 HCC 35
- K50.912 Crohn's disease, unspecified, with intestinal obstruction from V24 HCC 33, HCC 35
- K50.913 Crohn's disease, unspecified, with fistula from V24 HCC 35
- K50.914 Crohn's disease, unspecified, with abscess from V24 HCC 35
- K50.918 Crohn's disease, unspecified, with other complication from V24 HCC 35
- K50.919 Crohn's disease, unspecified, with unspecified complications from V24 HCC 35
Every code above carries the full HCC 80 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 80
What is HCC 80 in the CMS-HCC model?
HCC 80 is CMS-HCC Category 80 (Crohn's Disease (Regional Enteritis)) in the V28 risk adjustment model. It covers 28 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 80?
For payment year 2026, HCC 80 adds 0.550 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 0.374 to 0.651 across the seven payment segments shown above.
Which categories supersede HCC 80?
HCC 77 (Intestine Transplant Status/Complications) sits above HCC 80 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.
