V28 HCC 63
Chronic Liver Failure/End-Stage Liver Disorders
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 63 has a source-labeled community non-dual aged reference coefficient of 0.962, and 14 ICD-10-CM diagnosis codes appear in its official mapping. In the V28 hierarchy it is superseded by HCC 62 when a more severe category in the same disease group is also present.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.
These are source-labeled code-level HCC coefficient references, not a full member score. Use the RAF Calculator with complete member context for CMS-HCC V28 PY2026. No score is shown unless every required source and calculation check passes.
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)
ICD-10-CM codes in the official mapping for this category under CMS-HCC V28 PY2026. Open any code for its full description 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
Coder workflow notes
Get the V28 mapping + MEAT cheat sheet
A printable reference for HCC 63: representative mapping rows and MEAT reminders. Free, no card.
Free PDF. No card. Unsubscribe anytime.
Frequently asked questions
What is CMS-HCC V28 category 63?
HCC 63 is "Chronic Liver Failure/End-Stage Liver Disorders", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 14 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 63?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 63 is 0.962. The exact coefficient varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 model files.
How many ICD-10-CM codes map to HCC 63?
14 ICD-10-CM diagnosis codes appear in the official mapping for 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.
Related references
Sources
CMS ICD-10-CM order-file billability plus the published mapping and CMS-HCC V28 PY2026 model software. CMS-HCC V28 model published at CMS.gov Risk Adjustors; ICD-10-CM member codes from the CMS ICD-10-CM code set.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 30, 2026.