Question 1

What does HCC stand for in medical coding?

Accepted Answer

HCC stands for Hierarchical Condition Category. CMS uses HCC risk adjustment to estimate expected medical cost for Medicare Advantage members based on the diagnoses a provider reports during the year (CMS Risk Adjustment program: https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors).

Question 2

What is the difference between HCC model V24 and V28?

Accepted Answer

V24 is the 2020 CMS-HCC model with 86 payment HCCs; V28 is the 2024 model with 115 payment HCCs. For CY2026 non-PACE Medicare Advantage, CMS completed the V28 phase-in and uses 100% V28. PACE has a separate model blend. HCC Buddy labels mapping sources by payment year and date of service, with historical PY2025 V24 references shown separately. Sources: CMS December 2024 Report to Congress, Table 2-2 (https://www.cms.gov/files/document/report-congress-risk-adjustment-medicare-advantage-december-2024.pdf#page=29); CMS 2026 Rate Announcement (https://www.cms.gov/newsroom/fact-sheets/2026-medicare-advantage-part-d-rate-announcement).

Question 3

What is a RAF score and why does it matter?

Accepted Answer

A member RAF score combines demographic factors with applicable HCC coefficients after model hierarchy and cleanup rules, plus qualifying interaction terms. HCC Buddy's RAF Calculator supports seven continuing-enrollee segments in CMS-HCC V28 for Payment Year 2026 and requires complete member context. It shows no score unless the required source and calculation checks pass. Code-level coefficients are references, not member totals, and historical PY2025 V24 stays reference-only. PACE, new-enrollee, HHS and ESRD scoring are not supported. Source: CMS Risk Adjustment model software (https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment).

Question 4

What does the HCC Buddy Evidence Checker do?

Accepted Answer

Evidence Checker flags documentation gaps and conflicting wording for coder review. MEAT (Monitor, Evaluate, Assess, Treat) is a review mnemonic, not a substitute for the applicable ICD-10-CM guidelines. A flagged or unflagged result does not establish a diagnosis, reportability or audit acceptance.

Question 5

How many ICD-10-CM codes map to HCC categories?

Accepted Answer

For the FY2026 April edition, the published HCC Buddy reference includes 74,719 billable ICD-10-CM codes. Of those, 8,016 have a PY2026 V28 mapping, including six codes with a mapping condition. These are code counts, not HCC category counts or member RAF scores. Check the selected edition and source notes on the ICD-10 to HCC mapping page (https://hccbuddy.com/icd10-to-hcc).

Question 6

Is HCC Buddy free to try?

Accepted Answer

Yes. Start Pro and get 7 days to try the full workflow, no card required. Pro is $29.99/month standard or $199.99/year. The $19.99/month founding rate applies only to eligible accounts while the offer is open. See the live rate at https://hccbuddy.com/pricing.

Question 7

Can I paste patient notes into Ask Buddy?

Accepted Answer

No. HCC Buddy is built for deidentified coding questions, ICD-10-CM codes, and clinical concepts. Do not paste member identifiers, dates of birth, full chart notes, or other patient identifiers into Ask Buddy.

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