HCC risk score estimator

Paste ICD-10-CM codes and add demographics to estimate a CMS-HCC risk score with the V28 model that CMS uses for Medicare Advantage payment in 2026 and 2027. Every mapping, hierarchy, and coefficient is shown.

ICD-10-CM codes, one per line or separated by commas

0 codes

Runs on this device. Nothing you enter is sent anywhere. Don't include names or record numbers.

Age on February 1 of the payment year

Sex

Medicaid

Where they live

Originally disabledFirst entitled to Medicare by disability; applies at 65 and older

Loading the CMS-HCC V28 tables…

How it works

Each ICD-10-CM code is looked up in CMS's V28 mapping table from the PY 2027 model software. The table's age and sex edits are applied (for example, breast cancer maps to HCC 22 under 50 and HCC 23 at 50 and older).
Hierarchies are applied: when a more severe HCC in a family is present, the less severe ones are dropped (for example, diabetes with chronic complications drops diabetes without complications). A heart assist device counts only with heart failure, as in the CMS software.
The segment comes from age, Medicaid status, and setting: community aged (65 and older) or disabled (under 65), each split by non-dual, partial benefit dual, and full benefit dual, or long-term institutional.
The score adds the age and sex factor, originally disabled factor (65 and older) or institutional Medicaid factor, each remaining HCC, the interaction terms (for example diabetes with heart failure, heart failure with kidney disease), and the payment HCC count factor (5 or more HCCs in the community segments).
Optional payment steps: CMS divides the raw score by the normalization factor (1.079 for the 2024 CMS-HCC model in 2027) and then reduces it by the MA coding pattern adjustment (5.90%). Each step is rounded to three decimals.
Not included: the new enrollee model, ESRD models, frailty factors for PACE and FIDE SNPs, the RxHCC model, and CMS's diagnosis filtering (which encounter types and sources are allowed). This assumes every code entered is from an acceptable face-to-face source in the data collection year.

Sources

CMS: 2027 Model Software/ICD-10 Mappings: PY 2027 initial model software (Python, CMS_HCC_v28 package T1) and 2027 initial ICD-10-CM mappings
CMS: Risk Adjustment: model software and mappings for every payment year
CMS: CY 2027 Rate Announcement: 2024 CMS-HCC model used alone for 2027; normalization factor 1.079; MA coding pattern adjustment 5.90%

Educational estimate. This is not an official CMS calculation and is not for billing, payment, or quality reporting. Actual plan payment also depends on CMS's diagnosis filtering, enrollment status, and county rates. Tables built from the files above.