Frequently Asked Questions

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

Yes. Start Pro and get 7 days to try the full workflow, no card required. Pro includes full unlimited access and is $19.99/month for founding members during the founding window, then $29.99/month after it closes. Annual is $199.99/year.

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 7-day free trial ends, keep Pro to retain full access. Pro is $19.99/month for founding members during the founding window, then $29.99/month after it closes. Annual is $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. Annual Pro is $199.99/year, which works out to $16.67/month.

Founding member pricing is $19.99/month while the founding window is open. After the founding window closes, new monthly subscriptions move to the standard $29.99/month rate. Annual Pro is $199.99/year.

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

HCC Buddy is built for code lookup, HCC mapping, RAF context, and de-identified coding questions. It is not a place to store or process patient records; remove patient identifiers before using paste-based tools.

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.

After signing in, you can keep up to two personal guideline PDFs in Ask Buddy, up to 10MB each. PDFs need selectable text. The encoder Guidelines panel searches a separate public reference library.

HCC Buddy labels CMS-HCC V28 for CY2026 non-PACE use, CMS-HCC V24 as a historical PY2025 reference, and ESRD and RxHCC results by their own model versions. PACE requires a separate blended calculation.

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 CMS-HCC model versions. For organizations other than PACE, CMS blended them in CY2024 and CY2025 and uses V28 at full weight in CY2026. PACE follows a separate CY2026 blend. HCC Buddy labels V24 as a historical PY2025 reference from the CMS 2025 Midyear/Final mapping file.

MEAT stands for Monitor, Evaluate, Assess/Address, and Treat. It is an industry documentation-review mnemonic, not an official ICD-10-CM rule or CMS regulation. Use it to organize a review, then verify the diagnosis under the full record, official coding guidance, and the applicable encounter, program, and payer requirements.

The CMS-HCC V28 model has 115 payment HCC categories, up 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. The current CMS CY2026 V28 source maps 8,019 unique payable diagnosis codes. E11.65 maps to HCC 38, I50.9 maps to HCC 226, and J44.1 maps to HCC 280. HCC Buddy labels a verified mapping, a verified no-map, or source verification pending rather than filling in a missing result.

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 74,000 codes organized in 22 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 is a unique 10-digit provider identifier assigned through CMS NPPES. HCC Buddy lets you search registry records by name or NPI and review available provider details. An NPI does not establish licensing, credentialing, Medicare enrollment or eligibility to report a diagnosis; verify those separately.

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 in which CMS checks whether diagnoses submitted by Medicare Advantage organizations for risk adjustment are supported by enrollee medical records. Unsupported diagnoses can affect the recalculated risk score and overpayment recovery under the applicable audit rules. Use current CMS instructions and accurate ICD-10-CM coding; MEAT is only an optional review mnemonic.