CMS-HCC Risk Adjustment · V28 Model · Payment Year 2026 71 Codes

HCC 94: Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders ICD-10-CM

CMS-HCC Category 94 (Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.196 and 0.297 to a beneficiary's RAF score depending on the payment segment (0.268 for a community, non-dual, aged enrollee). 71 ICD-10-CM diagnosis codes map to HCC 94. A more severe related category (HCC 93) supersedes it when both are reported.

✓ Built from the official CMS PY 2026 risk adjustment filesV28 pays 100% of MA risk scores from PY 2026
+0.268
RAF, Community Non-Dual Aged
71
ICD-10-CM Codes
HCC 93
Superseded By
PY 2026
Dataset
CMS-HCC V28

RAF Weight by Payment Segment 7 segments

Payment SegmentRelative Factor
Community, non-dual, aged0.268
Community, partial-benefit dual, aged0.224
Community, full-benefit dual, aged0.237
Community, non-dual, disabled0.239
Community, partial-benefit dual, disabled0.196
Community, full-benefit dual, disabled0.250
Institutional0.297

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 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders) supersedes HCC 94 when reported together.

ICD-10-CM

ICD-10-CM Codes That Map to HCC 94 71 codes

71 of 71 shown
  • M02.30 Reiter's disease, unspecified site from V24 HCC 40
  • M02.311 Reiter's disease, right shoulder from V24 HCC 40
  • M02.312 Reiter's disease, left shoulder from V24 HCC 40
  • M02.319 Reiter's disease, unspecified shoulder from V24 HCC 40
  • M02.321 Reiter's disease, right elbow from V24 HCC 40
  • M02.322 Reiter's disease, left elbow from V24 HCC 40
  • M02.329 Reiter's disease, unspecified elbow from V24 HCC 40
  • M02.331 Reiter's disease, right wrist from V24 HCC 40
  • M02.332 Reiter's disease, left wrist from V24 HCC 40
  • M02.339 Reiter's disease, unspecified wrist from V24 HCC 40
  • M02.341 Reiter's disease, right hand from V24 HCC 40
  • M02.342 Reiter's disease, left hand from V24 HCC 40
  • M02.349 Reiter's disease, unspecified hand from V24 HCC 40
  • M02.351 Reiter's disease, right hip from V24 HCC 40
  • M02.352 Reiter's disease, left hip from V24 HCC 40
  • M02.359 Reiter's disease, unspecified hip from V24 HCC 40
  • M02.361 Reiter's disease, right knee from V24 HCC 40
  • M02.362 Reiter's disease, left knee from V24 HCC 40
  • M02.369 Reiter's disease, unspecified knee from V24 HCC 40
  • M02.371 Reiter's disease, right ankle and foot from V24 HCC 40
  • M02.372 Reiter's disease, left ankle and foot from V24 HCC 40
  • M02.379 Reiter's disease, unspecified ankle and foot from V24 HCC 40
  • M02.38 Reiter's disease, vertebrae from V24 HCC 40
  • M02.39 Reiter's disease, multiple sites from V24 HCC 40
  • M04.1 Periodic fever syndromes from V24 HCC 40
  • M04.2 Cryopyrin-associated periodic syndromes from V24 HCC 40
  • M04.8 Other autoinflammatory syndromes from V24 HCC 40
  • M04.9 Autoinflammatory syndrome, unspecified from V24 HCC 40
  • M06.4 Inflammatory polyarthropathy from V24 HCC 40
  • M12.00 Chronic postrheumatic arthropathy [Jaccoud], unspecified site from V24 HCC 40
  • M12.011 Chronic postrheumatic arthropathy [Jaccoud], right shoulder from V24 HCC 40
  • M12.012 Chronic postrheumatic arthropathy [Jaccoud], left shoulder from V24 HCC 40
  • M12.019 Chronic postrheumatic arthropathy [Jaccoud], unspecified shoulder from V24 HCC 40
  • M12.021 Chronic postrheumatic arthropathy [Jaccoud], right elbow from V24 HCC 40
  • M12.022 Chronic postrheumatic arthropathy [Jaccoud], left elbow from V24 HCC 40
  • M12.029 Chronic postrheumatic arthropathy [Jaccoud], unspecified elbow from V24 HCC 40
  • M12.031 Chronic postrheumatic arthropathy [Jaccoud], right wrist from V24 HCC 40
  • M12.032 Chronic postrheumatic arthropathy [Jaccoud], left wrist from V24 HCC 40
  • M12.039 Chronic postrheumatic arthropathy [Jaccoud], unspecified wrist from V24 HCC 40
  • M12.041 Chronic postrheumatic arthropathy [Jaccoud], right hand from V24 HCC 40
  • M12.042 Chronic postrheumatic arthropathy [Jaccoud], left hand from V24 HCC 40
  • M12.049 Chronic postrheumatic arthropathy [Jaccoud], unspecified hand from V24 HCC 40
  • M12.051 Chronic postrheumatic arthropathy [Jaccoud], right hip from V24 HCC 40
  • M12.052 Chronic postrheumatic arthropathy [Jaccoud], left hip from V24 HCC 40
  • M12.059 Chronic postrheumatic arthropathy [Jaccoud], unspecified hip from V24 HCC 40
  • M12.061 Chronic postrheumatic arthropathy [Jaccoud], right knee from V24 HCC 40
  • M12.062 Chronic postrheumatic arthropathy [Jaccoud], left knee from V24 HCC 40
  • M12.069 Chronic postrheumatic arthropathy [Jaccoud], unspecified knee from V24 HCC 40
  • M12.071 Chronic postrheumatic arthropathy [Jaccoud], right ankle and foot from V24 HCC 40
  • M12.072 Chronic postrheumatic arthropathy [Jaccoud], left ankle and foot from V24 HCC 40
  • M12.079 Chronic postrheumatic arthropathy [Jaccoud], unspecified ankle and foot from V24 HCC 40
  • M12.08 Chronic postrheumatic arthropathy [Jaccoud], other specified site from V24 HCC 40
  • M12.09 Chronic postrheumatic arthropathy [Jaccoud], multiple sites from V24 HCC 40
  • M30.0 Polyarteritis nodosa from V24 HCC 40
  • M30.2 Juvenile polyarteritis from V24 HCC 40
  • M30.8 Other conditions related to polyarteritis nodosa from V24 HCC 40
  • M31.5 Giant cell arteritis with polymyalgia rheumatica from V24 HCC 40
  • M31.6 Other giant cell arteritis from V24 HCC 40
  • M31.7 Microscopic polyangiitis from V24 HCC 40
  • M31.8 Other specified necrotizing vasculopathies from V24 HCC 108
  • M31.9 Necrotizing vasculopathy, unspecified from V24 HCC 108
  • M32.10 Systemic lupus erythematosus, organ or system involvement unspecified from V24 HCC 40
  • M32.11 Endocarditis in systemic lupus erythematosus from V24 HCC 40
  • M32.12 Pericarditis in systemic lupus erythematosus from V24 HCC 40
  • M32.13 Lung involvement in systemic lupus erythematosus from V24 HCC 40, HCC 112
  • M32.14 Glomerular disease in systemic lupus erythematosus from V24 HCC 40
  • M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus from V24 HCC 40
  • M32.19 Other organ or system involvement in systemic lupus erythematosus from V24 HCC 40
  • M32.8 Other forms of systemic lupus erythematosus from V24 HCC 40
  • M32.9 Systemic lupus erythematosus, unspecified from V24 HCC 40
  • M35.2 Behcet's disease from V24 HCC 40

Every code above carries the full HCC 94 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 94

What is HCC 94 in the CMS-HCC model?

HCC 94 is CMS-HCC Category 94 (Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders) in the V28 risk adjustment model. It covers 71 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.

What is the RAF weight for HCC 94?

For payment year 2026, HCC 94 adds 0.268 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.196 to 0.297 across the seven payment segments shown above.

Which categories supersede HCC 94?

HCC 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders) sits above HCC 94 in the hierarchy: when a beneficiary has diagnoses in both, only the more severe category is paid.

Related References

All HCC CategoriesHCC 93 CodesV24 to V28: What ChangedICD-10-CM Code Lookup

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.