Free CMS-HCC V28 Cheat Sheet for Risk Adjustment Coders
Use this page as the quick desk reference, then use HCC Buddy to check the exact ICD-10-CM code, billable status, V24/V28 mapping, RAF context, and documentation reminders before you rely on it.
By HCC Buddy Coding Team. Reviewed by CPC certified coding contributors. Educational reference only. Always verify the exact code, date of service, payer/program, and current CMS file before making a coding or payment decision.
First check: does the diagnosis belong in V28 workflow?
- 1Is the diagnosis active for the encounter, not only historical, resolved, or ruled out?
- 2Is the ICD-10-CM code valid and billable for the date of service?
- 3Does the provider note support the condition with monitor, evaluate, assess, or treat detail?
- 4Does the exact ICD-10-CM code map to a CMS-HCC category in the model for that payment year?
- 5Could a hierarchy, interaction, or payer-specific rule change how the risk score is explained?
A code can be valid and billable without being a V28 HCC. The HCC mapping is model-year sensitive, so do not use an old V24 crosswalk for current PY2026 non-PACE MA workflow.
V24 to V28 phase-in note
| Year | Blend | Coder note |
|---|---|---|
| PY/CY 2024 | 67% V24, 33% V28 | First phase-in year for the updated 2024 CMS-HCC model. |
| PY/CY 2025 | 33% V24, 67% V28 | Second phase-in year for non-PACE Medicare Advantage risk scores. |
| PY/CY 2026 | 100% V28 | Current non-PACE Medicare Advantage model weighting. PACE has a separate phase-in. |
CMS calls the updated model the 2024 CMS-HCC model. Coders often call it V28. RADV or retrospective work should follow the model for the payment year under review.
Representative V28 examples
These examples are pulled from the 2026 CMS-HCC V28 mapping files. They are not exhaustive. Click any code to check the live code page.
| Code | V28 HCC | Category | Coder reminder |
|---|---|---|---|
| E11.22 | HCC 37 | Diabetes with chronic complications | Check the linked CKD code and stage. The diabetes code and kidney code can both matter. |
| E11.9 | HCC 38 | Diabetes with no, glycemic, or unspecified complications | V28 maps uncomplicated type 2 diabetes to HCC 38. Still code only what is documented. |
| I50.23 | HCC 224 | Acute on chronic heart failure | Acuity changes the V28 category. Do not flatten acute-on-chronic wording to unspecified heart failure. |
| I50.22 | HCC 226 | Heart failure, except end stage and acute | Keep systolic, diastolic, chronic, acute, and acute-on-chronic language separate. |
| J44.1 | HCC 280 | Chronic lung disorders | COPD status and exacerbation wording affect code selection, even when the HCC category is the same. |
| I48.91 | HCC 238 | Specified heart arrhythmias | Use the documented atrial fibrillation type when the note supports it. |
| N18.32 | HCC 328 | CKD stage 3B | Stage 3A, 3B, stage 4, and stage 5 do not land the same way in V28. |
| N18.4 | HCC 327 | CKD stage 4 | Confirm the stage is documented, not inferred only from one lab value. |
| F33.1 | HCC 155 | Major depression, moderate or severe, without psychosis | Mild depression and history-only wording do not carry the same V28 meaning. |
| E66.01 | HCC 48 | Morbid obesity | Capture BMI only when coding rules and documentation support reporting the BMI code. |
Common no-HCC traps in V28
- I10Essential hypertension, uncomplicatedNo V28 CMS-HCC by itself.
- E78.5Hyperlipidemia, unspecifiedMay matter clinically, but not a V28 CMS-HCC.
- I25.10CAD, native vessel without anginaNo V28 CMS-HCC; do not assume CAD always risk-adjusts.
- I73.9Peripheral vascular disease, unspecifiedMapped in older CMS-HCC models, not V28 for 2026 payment.
- J45.909Unspecified asthma, uncomplicatedSevere persistent asthma is different. Check the exact code.
- Z87.-Personal history codes, such as Z87.891History wording is not the same as an active diagnosis.
MEAT reminder
MEAT is a useful coder shorthand. It does not replace official ICD-10-CM guidelines, payer requirements, provider query rules, or record-specific auditor judgment.
Source basis
We keep this page tied to public CMS and ICD-10-CM sources. Proprietary coding guidance, paid prep-bank material, and private payer manuals are not used for this public reference.
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V28 cheat sheet FAQ
What is in the HCC Buddy V28 cheat sheet?
The cheat sheet is a free quick reference for CMS-HCC V28 coder workflow. It includes the PY2026 model note, a V28 decision path, representative ICD-10-CM to HCC examples, common no-HCC traps, MEAT documentation reminders, and links to exact HCC Buddy code pages.
Which CMS-HCC model does the cheat sheet use?
The cheat sheet is focused on the CMS 2024 CMS-HCC risk adjustment model, commonly called V28 by coders, using the 2026 CMS model software and ICD-10-CM mappings. CMS finalized CY 2026 non-PACE Medicare Advantage risk scores at 100 percent of the 2024 CMS-HCC model. Prior payment years and some PACE workflows may require a different model or blend.
Is PY2026 still blended between V24 and V28?
For non-PACE Medicare Advantage risk adjustment, no. The V24 to V28 phase-in was 67 percent V24 and 33 percent V28 for 2024, then 33 percent V24 and 67 percent V28 for 2025, then 100 percent V28 for 2026. Retrospective audits still depend on the payment year being reviewed.
Do all ICD-10-CM codes map to an HCC in V28?
No. Many valid, billable ICD-10-CM codes do not map to a CMS-HCC payment category in V28. The page lists common traps such as uncomplicated hypertension and hyperlipidemia, but coders should check the exact code and payment year before relying on any quick reference.
Is the V28 cheat sheet free?
Yes. The online page and printable PDF are both free. Email signup is optional and is only for update notes when HCC Buddy publishes coding tips or refreshes the printable reference.