HCC 81: Ulcerative Colitis ICD-10-CM
CMS-HCC Category 81 (Ulcerative Colitis) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.201 and 0.286 to a beneficiary's RAF score depending on the payment segment (0.244 for a community, non-dual, aged enrollee). 49 ICD-10-CM diagnosis codes map to HCC 81. A more severe related category (HCC 77 and HCC 80) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.244 |
| Community, partial-benefit dual, aged | 0.205 |
| Community, full-benefit dual, aged | 0.201 |
| Community, non-dual, disabled | 0.285 |
| Community, partial-benefit dual, disabled | 0.237 |
| Community, full-benefit dual, disabled | 0.286 |
| Institutional | 0.258 |
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) and HCC 80 (Crohn's Disease (Regional Enteritis)) supersede HCC 81 when reported together.
ICD-10-CM Codes That Map to HCC 81 49 codes
- K51.00 Ulcerative (chronic) pancolitis without complications from V24 HCC 35
- K51.011 Ulcerative (chronic) pancolitis with rectal bleeding from V24 HCC 35
- K51.012 Ulcerative (chronic) pancolitis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.013 Ulcerative (chronic) pancolitis with fistula from V24 HCC 35
- K51.014 Ulcerative (chronic) pancolitis with abscess from V24 HCC 35
- K51.018 Ulcerative (chronic) pancolitis with other complication from V24 HCC 35
- K51.019 Ulcerative (chronic) pancolitis with unspecified complications from V24 HCC 35
- K51.20 Ulcerative (chronic) proctitis without complications from V24 HCC 35
- K51.211 Ulcerative (chronic) proctitis with rectal bleeding from V24 HCC 35
- K51.212 Ulcerative (chronic) proctitis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.213 Ulcerative (chronic) proctitis with fistula from V24 HCC 35
- K51.214 Ulcerative (chronic) proctitis with abscess from V24 HCC 35
- K51.218 Ulcerative (chronic) proctitis with other complication from V24 HCC 35
- K51.219 Ulcerative (chronic) proctitis with unspecified complications from V24 HCC 35
- K51.30 Ulcerative (chronic) rectosigmoiditis without complications from V24 HCC 35
- K51.311 Ulcerative (chronic) rectosigmoiditis with rectal bleeding from V24 HCC 35
- K51.312 Ulcerative (chronic) rectosigmoiditis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.313 Ulcerative (chronic) rectosigmoiditis with fistula from V24 HCC 35
- K51.314 Ulcerative (chronic) rectosigmoiditis with abscess from V24 HCC 35
- K51.318 Ulcerative (chronic) rectosigmoiditis with other complication from V24 HCC 35
- K51.319 Ulcerative (chronic) rectosigmoiditis with unspecified complications from V24 HCC 35
- K51.40 Inflammatory polyps of colon without complications from V24 HCC 35
- K51.411 Inflammatory polyps of colon with rectal bleeding from V24 HCC 35
- K51.412 Inflammatory polyps of colon with intestinal obstruction from V24 HCC 33, HCC 35
- K51.413 Inflammatory polyps of colon with fistula from V24 HCC 35
- K51.414 Inflammatory polyps of colon with abscess from V24 HCC 35
- K51.418 Inflammatory polyps of colon with other complication from V24 HCC 35
- K51.419 Inflammatory polyps of colon with unspecified complications from V24 HCC 35
- K51.50 Left sided colitis without complications from V24 HCC 35
- K51.511 Left sided colitis with rectal bleeding from V24 HCC 35
- K51.512 Left sided colitis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.513 Left sided colitis with fistula from V24 HCC 35
- K51.514 Left sided colitis with abscess from V24 HCC 35
- K51.518 Left sided colitis with other complication from V24 HCC 35
- K51.519 Left sided colitis with unspecified complications from V24 HCC 35
- K51.80 Other ulcerative colitis without complications from V24 HCC 35
- K51.811 Other ulcerative colitis with rectal bleeding from V24 HCC 35
- K51.812 Other ulcerative colitis with intestinal obstruction from V24 HCC 33, HCC 35
- K51.813 Other ulcerative colitis with fistula from V24 HCC 35
- K51.814 Other ulcerative colitis with abscess from V24 HCC 35
- K51.818 Other ulcerative colitis with other complication from V24 HCC 35
- K51.819 Other ulcerative colitis with unspecified complications from V24 HCC 35
- K51.90 Ulcerative colitis, unspecified, without complications from V24 HCC 35
- K51.911 Ulcerative colitis, unspecified with rectal bleeding from V24 HCC 35
- K51.912 Ulcerative colitis, unspecified with intestinal obstruction from V24 HCC 33, HCC 35
- K51.913 Ulcerative colitis, unspecified with fistula from V24 HCC 35
- K51.914 Ulcerative colitis, unspecified with abscess from V24 HCC 35
- K51.918 Ulcerative colitis, unspecified with other complication from V24 HCC 35
- K51.919 Ulcerative colitis, unspecified with unspecified complications from V24 HCC 35
Every code above carries the full HCC 81 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 81
What is HCC 81 in the CMS-HCC model?
HCC 81 is CMS-HCC Category 81 (Ulcerative Colitis) in the V28 risk adjustment model. It covers 49 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 81?
For payment year 2026, HCC 81 adds 0.244 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.201 to 0.286 across the seven payment segments shown above.
Which categories supersede HCC 81?
HCC 77 (Intestine Transplant Status/Complications) and HCC 80 (Crohn's Disease (Regional Enteritis)) sit above HCC 81 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.
