Chronic Liver Failure/End-Stage Liver Disorders
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 63 carries a community non-dual aged RAF of 0.962, and 14 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 62 when a more severe category in the same disease group is also present.
RAF factors
The community factor varies by Medicaid and originally-disabled status; the institutional factor applies to long-term-institutional members. These are the CMS-HCC V28 PY2026 relative factors.
V28 hierarchy
Trumped by: HCC 62 (a more severe category in the same disease group supersedes this one).
Supersedes: HCC 64, HCC 65, HCC 68, HCC 202 (this category is counted instead of these when they co-occur).
ICD-10-CM codes that map to HCC 63 (14)
Payable diagnosis codes that map to this category under CMS-HCC V28 PY2026. Open any code for its full description, HCC mapping, and coding guidance.
- I85.00Esophageal varices without bleeding
- I85.01Esophageal varices with bleeding
- I85.10Secondary esophageal varices without bleeding
- I85.11Secondary esophageal varices with bleeding
- K70.40Alcoholic hepatic failure without coma
- K70.41Alcoholic hepatic failure with coma
- K72.10Chronic hepatic failure without coma
- K72.11Chronic hepatic failure with coma
- K72.90Hepatic failure, unspecified without coma
- K72.91Hepatic failure, unspecified with coma
- K76.6Portal hypertension
- K76.7Hepatorenal syndrome
- K76.81Hepatopulmonary syndrome
- K76.82Hepatic encephalopathy
Frequently asked questions
What is CMS-HCC V28 category 63?
HCC 63 is "Chronic Liver Failure/End-Stage Liver Disorders", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 14 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 63?
The community non-dual aged relative factor for CMS-HCC V28 category 63 is 0.962. The exact factor varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 Rate Announcement.
How many ICD-10-CM codes map to HCC 63?
14 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 63 (Chronic Liver Failure/End-Stage Liver Disorders) for payment year 2026.
Which categories trump HCC 63 in the V28 hierarchy?
HCC 63 is superseded by HCC 62 (Liver Transplant Status/Complications). When a more severe category in the same disease group is documented, it is counted instead of HCC 63.
Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.