RAF Score Calculator
Calculate Medicare Advantage RAF scores from demographics and HCC codes using the CMS-HCC V24 and V28 models — free, right here in your browser. Nothing you enter leaves your device (Zero PHI).
Calculate Your RAF ScoreFree · Runs in your browser · Source: 2026 CMS Rate Announcement, official CMS-HCC coefficients
Enter patient details
Set the model, demographics, and HCC codes, then Calculate RAF Score to see the full breakdown — demographic base, condition coefficients, disease interactions, and hierarchy drops.
Calculations run entirely in your browser using official CMS-HCC V24/V28 coefficients — no patient data is sent to a server. Open the full encoder to look up ICD-10 codes and auto-map HCCs into a RAF calculation.
What Is a RAF Score?
The Risk Adjustment Factor (RAF) score is a numeric value used by the CMS Medicare Advantage risk adjustment program to predict the expected healthcare costs for a Medicare Advantage beneficiary. RAF scores drive capitated payment amounts to health plans: a higher score means higher expected costs and larger reimbursement. The CMS-HCC (Hierarchical Condition Category) model calculates RAF scores from three components: a demographic base factor, condition category coefficients, and disease interaction terms. HCC Buddy's RAF Score Calculator uses coefficients from the official 2026 CMS-HCC model software and ICD-10 mappings for both V24 and V28 models. For a plain-language overview of how HCC categories work in primary care reimbursement, the AAFP Hierarchical Condition Category guide is a widely cited physician-facing reference.
What to check before you trust the RAF number
- Use the payment-year model that matches the chart or audit period. V28 is current for 2026 payment-year modeling, while older RADV work may still need V24 or a blend.
- Confirm every HCC has current MEAT support in the provider note. RAF math is only useful when the documentation backs the submitted condition.
- Look for hierarchy suppression before explaining a score change. A more severe HCC can replace a lower related HCC instead of adding to it.
Source basis: CMS-HCC model software, CMS risk adjustment materials, and HCC Buddy original coder-facing guidance. This page does not reproduce AHA Coding Clinic content.
How the Calculator Works
Enter demographics
Select age, sex, and enrollment type to set the base demographic factor.
Add HCC codes
Enter HCC numbers directly or search by ICD-10 code to auto-map to the correct category.
Get RAF score
See the total score with a full breakdown: base factor, condition coefficients, and interaction terms.
V24 and V28: which model to use
CMS transitioned Medicare Advantage from the V24 model to V28 over the 2024 to 2026 payment years. V28 recalibrated coefficients, removed some HCC categories, and mapped ICD-10-CM codes more granularly. The 2026 payment year uses V28 at full weight. For RADV audits covering prior years, the applicable model depends on the payment year under review, not the audit year. HCC Buddy calculates both V24 and V28 scores in parallel so coders can compare the impact without switching tools.
The RAF calculator in HCC Buddy is integrated with the ICD-10-CM encoder, so when you look up a code and confirm its HCC mapping, you can add it to the RAF calculation directly from the same workspace.
Based on official CMS-HCC model coefficients from the 2026 Rate Announcement
Frequently Asked Questions
Coder workflow notes
Get RAF workflow notes.
Short notes on V24, V28, HCC interactions, and the checks coders use when a RAF score changes.
Short notes only. Unsubscribe anytime.
From the Blog
RAF Score Calculation Guide: How Risk Adjustment Factors Work
A complete guide to RAF score components, demographic factors, and HCC weights.
Free RAF Score Calculator: How Risk Adjustment Works in 2026
How to use the RAF calculator for Medicare Advantage patient modeling.
HCC V28 Changes 2026: Complete Guide to the New Model
What changed in V28, how the 2026 blend works, and how to adapt your workflow.