RAF Score Calculator: How to Calculate Risk Adjustment Factor for Medicare Advantage

The coefficients every calculator relies on come from the CMS 2026 risk-adjustment model software and ICD-10 mappings release. For a deeper look at what RAF scores are and why they exist, see how RAF scores work in detail.

What Inputs Does a RAF Score Calculator Need?

A RAF score calculator is only as accurate as the data fed into it. Before running any calculation, you need four categories of inputs:

Demographic inputs determine the patient's baseline coefficient. These include:

Diagnosis inputs are the complete ICD-10-CM diagnosis set supported by the record for the selected context. Enter the codes, not a manually reduced HCC list. The server checks code validity, applies the selected model mappings and hierarchy, and calculates applicable interactions. Review the returned mapping and suppression lines before using the result.

Model context determines which coefficient table applies. The HCC Buddy member scorer runs CMS-HCC V28 for Payment Year 2026. Historical PY2025 V24 remains a mapping and coefficient reference, and PACE needs its own blended calculation.

Interaction terms are additional model factors triggered by specific combinations of diagnoses, HCCs or member characteristics. Their conditions vary by model and segment. Use the registered CMS rules and the returned calculation lines; do not add an interaction because two conditions commonly occur together.

How HCC Buddy checks a result

> RAF Calculator: The RAF Calculator supports CMS-HCC V28 for Payment Year 2026 and requires complete member context. HCC Buddy shows a score only after the server confirms the required source and calculation checks. If a check is unavailable or does not pass, no score is shown.

Static code-level coefficients are references, not member totals. Historical PY2025 V24 stays reference-only.

Using a RAF Score Calculator for Gap Analysis

A RAF score calculator is not just for end-of-year reconciliation. Coders and coding managers use it throughout the year for both prospective and retrospective purposes.

Hypothetical comparisons, You can compare clearly labeled hypothetical diagnosis sets for planning. Keep these scenarios separate from finalized member calculations and submission data. A score difference does not establish a diagnosis or justify reporting it. Finalized inputs must reflect the supported, reportable diagnoses and complete member context.

Retrospective verification, Submit the complete supported ICD-10-CM diagnosis set and matching member context, then inspect the returned calculation lines. Compare like-for-like model, payment year, segment and score type before investigating a discrepancy.

Team review, The CMS-HCC V28 PY2026 RAF tool calculates one member context at a time. It does not estimate an expected panel RAF from narrative clinical complexity. If your team compares aggregate results elsewhere, use matching populations, model years and score types. Investigate differences instead of assuming that a lower average proves missed coding.

The result depends on the supported diagnosis set and member context. A wrong code, omitted diagnosis or mismatched source period can change the calculation. Review code selection separately from its mapping and payment effect.

RAF Tool in HCC Buddy

Use the encoder to confirm each ICD-10-CM code's current CY2026 V28 result and historical PY2025 V24 reference. Those mapping and coefficient references are separate from a member score.

Run member scoring in the RAF tool with the complete diagnosis set, age, sex, original reason for entitlement, supported segment, and institutional Medicaid months when applicable. A passing V28 PY2026 response shows raw, normalized, and payment-adjusted scores plus the calculation lines. Otherwise, it shows no score.

Use the Chrome extension for source-labeled HCC lookups beside browser-based chart work. Member scoring stays in the RAF tool with the complete diagnosis set and member details. PACE requires its own blended calculation.

Common Mistakes When Calculating RAF Scores

Even experienced coders make these errors when working without a structured tool:

The HCC Buddy RAF tool returns a CMS-HCC V28 PY2026 member result only for supported non-PACE contexts with the complete diagnosis set and member details. Historical PY2025 V24 remains a reference, not a member score.