Free RAF score calculator
Free RAF Score Calculator (CMS-HCC V28 & V24)
Estimate a Medicare Advantage risk score from demographics and confirmed HCCs. Use V28 for Payment Year 2026 or V24 for earlier-model review. Same official CMS coefficients, free, no card.
Free · Runs in your browser · Source: 2026 CMS Rate Announcement, official CMS-HCC coefficients
What Is a RAF Score?
A Risk Adjustment Factor (RAF) score is the number CMS uses to predict a Medicare Advantage patient's expected cost: a demographic base factor plus a weight for each documented condition that maps to a payment HCC, plus any disease interactions. The calculator below runs that math with the official CMS-HCC coefficients, and when you enter ICD-10 codes it shows the V28 and V24 results side by side.
- CMS completed the three-year phase-in of the V28 model in 2026: 100% of non-PACE risk scores are calculated under it. CMS 2026 Rate Announcement fact sheet, April 7, 2025.
- Before the CMS coding adjustment, MedPAC projected Medicare Advantage risk scores would run about 10% higher than scores for similar fee-for-service beneficiaries. MedPAC March 2026 report.
More sourced numbers on enrollment, payment, and RADV oversight live in the HCC coding statistics reference.
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. Enter ICD-10 codes to also get a V28-vs-V24 comparison.
Calculations use the official CMS-HCC V24 and V28 coefficients. Open the full encoder to look up ICD-10 codes and auto-map HCCs into a RAF calculation.
Video lesson
How to Calculate a RAF Score in 2026 (Real Example to 0.968)
A worked RAF example under the 2026 CMS-HCC V28 model: demographic base 0.330, E11.9 (HCC 38, +0.166), I50.9 (HCC 226, +0.360), and the diabetes × heart failure interaction (+0.112) add up to a 0.968 risk score.
Key takeaways
- A RAF score starts from a demographic base, then adds HCC weights and interaction terms. In this 2026 V28 example, a 68-year-old community-dwelling, non-dual woman starts at 0.330.
- E11.9 (type 2 diabetes without complications) maps to HCC 38 and adds 0.166; I50.9 (heart failure, unspecified) maps to HCC 226 and adds 0.360.
- Diabetes plus heart failure triggers an automatic V28 interaction of +0.112 — total RAF 0.968.
- Hierarchies pay only the top rung: if the chart later supports E11.22 (HCC 37), it supersedes HCC 38 — the model never stacks two diabetes HCCs.
- CMS publishes new coefficients every payment year, so always check which model and year your weights come from.
Read the full transcript
Meet Edna. She is 68, she grows the best tomatoes on her block, and her chart says two things: type 2 diabetes, and a heart that is getting tired. Her Medicare Advantage plan gets paid to take care of the real Edna, and that payment starts with one number: the RAF score. Let me show you how her story becomes that number.
Every visit tells part of her story. Her doctor writes it down in the chart, and a risk adjustment coder, that is where I come in, translates that chart into ICD-10 codes. Only what is documented this year counts, so every condition has to be told again, every single year.
Before a single diagnosis is counted, CMS looks at who Edna is. A woman, 68 years old, living at home in the community, not dual eligible. In the 2026 V28 model, that profile starts her score at 0.330. Think of it as the opening line of her story.
Now her conditions join the story. Type 2 diabetes without complications is E11.9. In V28, E11.9 lands in HCC 38, and HCC 38 adds 0.166 to her score. Her plan is being paid, in advance, to manage her diabetes all year.
Her tired heart is chapter two. Heart failure, unspecified, is I50.9, and it lands in HCC 226, worth 0.360. Notice that is more than twice the diabetes weight. The sicker the condition, the bigger the line in the story. The model pays for severity, not for how many codes you stack.
And here is the part most people miss. When diabetes and heart failure show up in the same patient, V28 adds an interaction bonus: 0.112, automatically. Two conditions together are harder to manage than each one alone, and the model knows it.
Add up Edna's story. 0.330 to start. 0.166 for diabetes. 0.360 for her heart. 0.112 for the combination. Her RAF score is 0.968, and that number decides what her plan is paid to keep her gardening.
One trap before you go. Say next spring, Edna's diabetes progresses, and her chart now supports E11.22, diabetes with chronic kidney disease. That is HCC 37, a higher rung on the same ladder as HCC 38. When both are coded, only the top rung pays. The model never stacks two diabetes HCCs, so code to the highest specificity the chart supports, and let the hierarchy do its job.
One more thing. These weights are not carved in stone. CMS publishes new coefficients every payment year, so Edna's number can change even when Edna does not. Always check which model and which year your weights come from.
You do not have to do Edna's math by hand. We keep a free RAF calculator at hccbuddy.com/raf, with the current V28 and V24 weights, interactions, and hierarchies built in. Type in her two codes, hit calculate, and there is her 0.968, line by line, with the V24 comparison beside it. Find the codes. Check the math. Keep moving. That is HCC Buddy.
Three worked RAF examples, with the arithmetic shown
The fastest way to trust a calculator is to check it by hand. Each example below is computed with the official CMS coefficients, shown line by line for both models. Recreate any of them in the calculator above by entering the ICD-10 codes.
Type 2 diabetes, no complications
A 68-year-old woman, community-enrolled, non-dual, aged (CNA). One documented chronic condition: type 2 diabetes without complications, coded E11.9 with MEAT support.
| Component | V28 (PY2026) | V24 |
|---|---|---|
| Demographic base (Female, 65-69, Community Non-Dual Aged) | 0.330 | 0.323 |
| E11.9 Type 2 diabetes mellitus without complications | HCC 38: +0.166 | HCC 19: +0.105 |
| Total RAF | 0.496 | 0.428 |
One supported HCC on top of the demographic base. Note the V28 and V24 category numbers differ for the same code, and so do the weights. The category number is model-specific, the diagnosis is not.
Diabetes plus heart failure
A 74-year-old man, community-enrolled, non-dual, aged (CNA). Two documented conditions: type 2 diabetes (E11.9) and unspecified heart failure (I50.9).
| Component | V28 (PY2026) | V24 |
|---|---|---|
| Demographic base (Male, 70-74, Community Non-Dual Aged) | 0.396 | 0.394 |
| E11.9 Type 2 diabetes mellitus without complications | HCC 38: +0.166 | HCC 19: +0.105 |
| I50.9 Heart failure, unspecified | HCC 226: +0.360 | HCC 85: +0.331 |
| Disease interactions | Diabetes*Heart Failure: +0.112 | DIABETES CHF: +0.121 |
| Total RAF | 1.034 | 0.951 |
Two conditions add two HCC weights, and when a model pays a disease interaction for the pair, the interaction row appears on top. Miss the second diagnosis in documentation and the score loses the condition weight and any interaction with it.
CKD hierarchy: the higher stage absorbs the lower
A 71-year-old woman, community-enrolled, non-dual, aged (CNA). The chart documents CKD stage 5 (N18.5) and an older note still carries CKD stage 3a (N18.31).
| Component | V28 (PY2026) | V24 |
|---|---|---|
| Demographic base (Female, 70-74, Community Non-Dual Aged) | 0.395 | 0.386 |
| N18.5 Chronic kidney disease, stage 5 | HCC 326: +0.815 | HCC 136: +0.289 |
| N18.31 Chronic kidney disease, stage 3a | HCC 329: 0.000 (superseded by HCC 326) | HCC 138: 0.000 (superseded by HCC 136) |
| Total RAF | 1.210 | 0.675 |
Hierarchies keep the most severe condition in a family and zero out the rest. The stage 3 row shows a struck-through zero, not an added weight. Submitting both codes is fine; only the higher one pays.
The demographic base every score starts from
Before any diagnosis is counted, the model assigns a base factor from age, sex, and enrollment status. These are the V28 community non-dual aged (CNA) rows the calculator uses.
| Age band | Female | Male |
|---|---|---|
| 65-69 | 0.330 | 0.332 |
| 70-74 | 0.395 | 0.396 |
| 75-79 | 0.465 | 0.502 |
| 80-84 | 0.524 | 0.571 |
| 85-89 | 0.624 | 0.664 |
| 90-94 | 0.737 | 0.800 |
| 95+ | 0.742 | 0.896 |
Source: official CMS-HCC V28 model coefficients, community non-dual aged column.
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: official 2026 CMS-HCC model software and ICD-10 mappings, the CMS Medicare Advantage risk adjustment program, and HCC Buddy original coder-facing guidance. For a physician-facing overview, the AAFP Hierarchical Condition Category guide is a widely cited reference. 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 map the diagnosis to its category.
Review the RAF score
See the demographic base, condition coefficients, hierarchy results, and any interaction terms in the total.
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. Enter ICD-10 codes in the calculator above and it resolves each code through both models' own mappings, then shows the V28 and V24 results side by side, so you can compare the impact without switching tools. For category detail, use the HCC V28 reference.
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.
How RAF Scores Work: Risk Adjustment Factor Scores Explained
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 phase-in to 100% V28 works, and how to adapt your workflow.