Frequently Asked Questions

HCC Buddy is an ICD-10-CM encoder with built-in HCC category mappings, NPI provider lookup, drug-to-diagnosis reference, AI coding assistant, and more. It’s available as a Chrome extension and at hccbuddy.com.

Yes. Every new account starts with a 14-day free trial — full unlimited access, no credit card required. After the trial, subscribe to Pro at $19.99/month (founding member rate) or $199.99/year to keep unlimited access.

Visit the Chrome Web Store, search “HCC Buddy”, and click “Add to Chrome.” The extension opens as a side panel right inside your browser.

After your 14-day free trial ends, subscribe to Pro to keep full access. Plans start at $19.99/month (founding member rate) or $199.99/year.

Yes. You can cancel your subscription at any time. Your access continues through the end of your current billing period. No refunds are provided for partial periods.

Yes. The annual plan is $199.99/year (founding member rate), which saves you about $40 compared to paying $19.99/month. That works out to just $16.67/month.

Early supporters who subscribe during our launch window (first 500 users or 6 months, whichever comes first) are locked in at $19.99/month for 2 years, as long as their subscription stays active. After the 2-year lock, you’ll move to the standard rate.

No. HCC Buddy does not collect, store, or transmit any Protected Health Information (PHI). See our security page for architecture details.

HCC Buddy is not a HIPAA covered entity. It is designed with a HIPAA-conscious architecture that actively prevents PHI from entering our systems. No Business Associate Agreement is needed because no PHI is processed.

We collect your email address, a hashed password, and basic usage counts. We do not collect browsing history, patient data, or any Protected Health Information. See our privacy policy for full details.

Only you. Your searches are not shared, sold, or used for advertising.

HCC Buddy includes ICD-10-CM codes from fiscal years 2016 through 2026, updated annually with CMS releases.

The Chrome extension caches some data locally, but most features require an internet connection for full functionality.

Yes. Pro subscribers can upload PDF guidelines for AI-powered search and reference within the guidelines library.

HCC Buddy supports V28 (current CMS-HCC), V24 (legacy), ESRD, and RxHCC models.

HCC stands for Hierarchical Condition Category. It is a risk adjustment model used by the Centers for Medicare and Medicaid Services (CMS) to predict healthcare costs based on the diagnoses reported for each patient. Each HCC category groups related ICD-10-CM codes that represent similar clinical conditions and cost patterns.

V24 and V28 are different versions of the CMS-HCC risk adjustment model. V28, phased in starting 2024, consolidates HCC categories from 86 to 115 payment HCCs, removes some lower-acuity conditions, and changes RAF weights. During the transition period (2024-2025 blend, full V28 in 2026), coders must understand both models because the same ICD-10-CM code may map to different HCC categories or different RAF weights depending on the model version.

MEAT stands for Monitor, Evaluate, Assess/Address, and Treat. It is the documentation standard used to determine whether a condition has been adequately documented to support ICD-10-CM code assignment for risk adjustment. For an HCC to be captured, the provider’s note must show at least one MEAT element for that condition during the encounter.

The CMS-HCC V28 model has 115 payment HCC categories, down from the 86 payment HCCs in the V24 model. Although the number increased, V28 removed several lower-acuity conditions and consolidated others, resulting in a model that more precisely predicts costs for higher-severity diagnoses.

A Risk Adjustment Factor (RAF) score is a numeric value assigned to each Medicare Advantage enrollee that represents their predicted healthcare costs relative to the average beneficiary. A RAF score of 1.0 means average expected cost. Higher scores (driven by more documented HCC conditions) result in higher capitation payments to the health plan. Accurate RAF scores depend on complete and accurate ICD-10-CM coding.

Only a subset of ICD-10-CM codes map to HCC categories under the CMS risk adjustment model. Approximately 9,500 of the 72,000+ ICD-10-CM codes have HCC mappings. Common mapping examples include E11.65 (Type 2 Diabetes Mellitus with Hyperglycemia) mapping to HCC 37, I50.9 (Heart Failure) mapping to HCC 226, and J44.1 (Chronic Obstructive Pulmonary Disease with Acute Exacerbation) mapping to HCC 228. HCC Buddy shows the HCC mapping for every code instantly.

An Excludes1 note means ‘not coded here’ — the two conditions are mutually exclusive and cannot be reported together on the same claim. An Excludes2 note means ‘not included here’ — the conditions are distinct and may be coded together if both are documented. Understanding this difference is critical for accurate ICD-10-CM coding and HCC capture.

No. Most ICD-10-CM codes do not map to an HCC category. Only codes representing conditions that significantly predict future healthcare costs are included in the CMS-HCC model. For example, essential hypertension (I10) does not map to any HCC in the V28 model, while hypertensive heart disease (I11.0) maps to HCC 226. HCC Buddy clearly labels which codes have HCC mappings and which do not.

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is the medical coding system used in the United States for reporting diagnoses. It contains over 72,000 codes organized in 21 chapters, ranging from infectious diseases to injury codes. Each code can be 3 to 7 characters long and provides increasing specificity about the condition.

An NPI (National Provider Identifier) is a unique 10-digit identification number assigned to healthcare providers by CMS. Medical coders need NPI numbers to correctly identify rendering, referring, and ordering providers on claims. HCC Buddy includes an NPI lookup tool with access to 9.37 million provider records searchable by name, NPI number, specialty, or location.

ICD-10-CM is updated twice per year by CMS. The major annual update takes effect on October 1 (the start of the federal fiscal year) and typically includes new codes, revised codes, and deleted codes. A smaller mid-year update takes effect on April 1 and usually focuses on instructional note changes, Excludes note revisions, and sequencing updates rather than new codes.

CMS-RADV (Risk Adjustment Data Validation) is an audit program where CMS reviews medical records to verify that the diagnoses submitted by Medicare Advantage plans are supported by clinical documentation. If an HCC code cannot be validated through the medical record, the plan must return the associated risk adjustment payment. Accurate ICD-10-CM coding with proper MEAT documentation is the best defense against RADV findings.