2027 MA Rate Announcement: What HCC Coders Need to Know

Quick Answer

CMS finalized the 2027 Medicare Advantage Rate Announcement on April 6, 2026, and the coder takeaway is more specific than the headline payment increase.

For Part C risk adjustment, CMS did not finalize a new Medicare Advantage HCC model for 2027. Instead, CMS will keep using the 2024 MA risk adjustment model, the same model already in place for 2026. CMS did finalize two source-of-diagnosis changes for 2027. Diagnoses from audio-only services will be excluded from risk score calculation, and diagnoses from unlinked chart review records will also be excluded, with a limited exception for beneficiaries who switch from one MA organization to another.

For HCC coders, that means your day-to-day code mapping workflow does not reset again for 2027, but your documentation support and chart-review workflow still matter a lot.

What Changed In The Final 2027 Rate Announcement

The 2027 Rate Announcement moved in two directions at once.

First, CMS increased expected average MA payments by 2.48 percent year over year, or more than $13 billion, according to the final fact sheet. Second, CMS kept tightening how certain diagnoses count for risk scores.

The most coder-relevant final decisions were these:

1. CMS Kept The Current Part C HCC Model For 2027

In the January 26, 2026 Advance Notice, CMS proposed updating the Part C risk adjustment model with more recent Original Medicare data.

In the April 6, 2026 final Rate Announcement, CMS stepped back from that proposal for Medicare Advantage organizations and said it will continue to use the 2024 MA risk adjustment model for CY 2027.

That matters because coders do not need to learn a brand-new Part C model for 2027 on top of the V28 transition that just fully landed in Payment Year 2026.

2. Audio-Only Diagnoses Will Not Count For 2027 Risk Scores

CMS finalized the exclusion of diagnoses identified as resulting from audio-only services using modifiers 93 or FQ.

If a diagnosis comes from an audio-only service, it may still matter clinically and operationally, but CMS says it will not be used for risk score calculation in CY 2027.

3. Most Unlinked Chart Review Diagnoses Will Not Count Either

CMS also finalized the exclusion of diagnoses from unlinked chart review records, often shortened to unlinked CRRs, from risk score calculation.

The narrow exception is for beneficiaries who switch from one MA organization to another. For everyone else, diagnoses submitted from an unlinked chart review record will not count toward the risk score.

This is the same broad direction coders saw in the January proposal, but now it is final policy for 2027.

What Did Not Change For Coders

If you were bracing for another full model reset, this is the calmer part.

CMS says it will continue to use the 2024 MA risk adjustment model for non-PACE MA organizations in CY 2027. In practical coder language, that means the active Part C scoring model for 2027 stays aligned with the model coders already use in 2026.

That does not mean nothing matters. It means the main coding pressure point is not a brand-new HCC map. The pressure point is whether the diagnosis source and chart support are defensible.

What HCC Coders Should Recheck Now

Does This Diagnosis Come From A Valid Risk-Score Source?

For 2027, source-of-diagnosis rules deserve as much attention as the code itself.

If the diagnosis came from an audio-only service, it should raise a payment-workflow question. If it came from a chart review record that is not linked to a beneficiary encounter, it should raise the same question.

Coders and QA leads should stop treating every submitted diagnosis as equal. The source now matters more.

Is The Diagnosis Linked To A Real Encounter?

The unlinked chart review policy is a reminder that CMS wants stronger encounter connection.

If your workflow relies on retrospective chart review findings, make sure the diagnosis is tied to a valid encounter record and supported in the medical documentation being used for risk adjustment. A diagnosis that looks clinically plausible is not enough if the payment source pathway is weak.

Is Your 2027 Training Still Teaching A New Model Rollout?

Some teams may still have draft education materials built around the January 2026 proposal.

Those materials need a reset. The final policy did not adopt a new Part C MA risk adjustment model for 2027. If your training deck says coders need to learn a new MA HCC model for 2027, it is already stale.

Are You Still Over-Relying On Chart Review Alone?

This is the operational risk buried inside the policy update.

If a team built productivity around unlinked chart review captures, that workflow is now weaker for payment purposes in 2027. The safest adjustment is to tighten encounter-linked documentation review, provider-addressed conditions, and support checks before submission.

What Team Leads And QA Managers Should Do This Week

Start with a small, boring audit. That is usually enough.

Pull a sample of diagnoses sourced from chart review workflows and ask:

That review will tell you whether the real gap is coder education, source tagging, encounter linkage, or documentation support.

Where HCC Buddy Fits

HCC Buddy helps coders check ICD-10-CM code details, HCC mapping, RAF impact, and related references faster.

It does not replace coder judgment, and it does not decide whether a diagnosis came from a risk-adjustment-eligible source. That still belongs to the coder, the reviewer, and the documented record.

For this 2027 update, the biggest value is speed on the lookup side so your team can spend more time on the part CMS is tightening, source quality and encounter support.

Sources

CMS 2027 Medicare Advantage and Part D Rate Announcement fact sheet

CMS 2027 Rate Announcement PDF

CMS 2027 Advance Notice fact sheet

CMS 2027 Advance Notice PDF

CMS Medicare Advantage announcements and documents page

Review the HCC Buddy V28 transition guide.