HCC risk adjustment coding
The reference hub for HCC coders working Medicare Advantage. Start with the CMS-HCC V28 category list, map any ICD-10-CM code to its HCC, and check the RAF and MEAT documentation it needs.
Start here
- CMS-HCC V28 categoriesThe full list of V28 payment categories, each with its RAF, hierarchy, and payable ICD-10-CM member codes.
- What changed in V28How the V28 model differs from V24: remapped categories, removed codes, and the PY2026 phase-in.
- ICD-10 to HCC crosswalkLook up any ICD-10-CM code and see the CMS-HCC V28 category it maps to, with the RAF weight.
- ICD-10-CM chaptersBrowse risk-adjusting codes by ICD-10-CM chapter and the HCC categories each chapter hits.
- Conditions libraryCommon Medicare Advantage conditions with their HCC categories, codes, and documentation guidance.
- MEAT documentationHow to support a reported diagnosis with Monitoring, Evaluation, Assessment, and Treatment for RADV.
Browse CMS-HCC V28 categories
The highest-volume V28 payment categories by payable ICD-10-CM code count, grouped by clinical family. Open any category for its RAF segment factors, V28 hierarchy, and member codes.
Diabetes & endocrine
Cardiovascular & heart failure
- HCC 226 — Heart Failure, Except End Stage and Acute34
- HCC 227 — Cardiomyopathy/Myocarditis14
- HCC 225 — Acute Heart Failure (Excludes Acute on Chronic)6
- HCC 224 — Acute on Chronic Heart Failure3
- HCC 222 — End Stage Heart Failure1
- HCC 263 — Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene127
- HCC 264 — Vascular Disease with Complications71
- HCC 249 — Ischemic or Unspecified Stroke95
- HCC 248 — Intracranial Hemorrhage53
Kidney disease (CKD)
Respiratory (COPD & lung)
Mental & behavioral health
- HCC 155 — Major Depression, Moderate or Severe, without Psychosis371
- HCC 154 — Bipolar Disorders without Psychosis27
- HCC 152 — Psychosis, Except Schizophrenia12
- HCC 151 — Schizophrenia12
- HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications308
- HCC 135 — Drug Use with Psychotic Complications97
Neurological & dementia
Cancer & neoplasms
- HCC 21 — Lymphoma and Other Cancers463
- HCC 23 — Prostate, Breast, and Other Cancers and Tumors234
- HCC 20 — Lung and Other Severe Cancers233
- HCC 22 — Bladder, Colorectal, and Other Cancers126
- HCC 17 — Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic78
- HCC 19 — Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers68
Showing 37 high-frequency V28 categories across the most-coded clinical families. The number is each category's payable ICD-10-CM code count. View all 115 CMS-HCC V28 categories.
Frequently asked questions
What is HCC risk adjustment?
HCC risk adjustment is how CMS adjusts Medicare Advantage payments for the health status of each beneficiary. Reported ICD-10-CM diagnoses map to Hierarchical Condition Categories (HCCs), and each HCC carries a relative factor (RAF) that raises the beneficiary's risk score and the plan's payment.
Which HCC model applies in 2026?
Payment year 2026 uses CMS-HCC V28 at 100 percent phase-in. V24 is fully retired for payment, though many coders still reference V24 for retrospective and audit work. HCC Buddy shows both mappings on every code.
What does a coder need to capture an HCC?
The diagnosis must be documented to the highest specificity, supported by MEAT in the visit note, coded from an active provider assessment, and reported at least once in the calendar year. Each condition recaptures annually, so it must be documented again each year to count.