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.
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.