CMS-HCC V28
HCC risk adjustment coding
The reference hub for Medicare Advantage HCC coding. Start with the CMS-HCC V28 category list, verify source-labeled ICD-10-CM mappings, and review model-specific factors and documentation context.
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- 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 an ICD-10-CM code and see its available CMS-HCC V28 mapping. Code-level coefficients are source-labeled references, not member totals.
- 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.
- HCC coding statisticsFifty source-linked statistics on Medicare Advantage enrollment, payment, coding intensity, RADV audits, and coding work in 2026.
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?
Medicare Advantage risk adjustment is CMS's method for adjusting plan payments to reflect differences in expected costs using beneficiary demographic and diagnosis data under the applicable model. CMS-HCC models use diagnosis and demographic data to predict expected expenditures. A supported ICD-10-CM diagnosis may map to one or more HCCs. CMS then applies the selected model's hierarchy, coefficient, and interaction rules when calculating a risk score. A mapping or code-level coefficient is not a member's final RAF or payment.
Which HCC model applies in 2026?
CY2026 organizations other than PACE use CMS-HCC V28 at full weight. HCC Buddy shows the current V28 result beside a labeled PY2025 historical V24 reference. PACE uses a separate CY2026 blend and cannot be represented by one V28 or V24 value.
What does a coder need to capture an HCC?
Assign the ICD-10-CM code supported by the record and the official classification, then verify that the diagnosis, encounter, provider, date of service, and submission meet the applicable CMS program and payer requirements. MEAT can be used as a review mnemonic, but one MEAT element does not make a diagnosis reportable and a code-to-HCC mapping does not prove documentation support.