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. 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.
