HCC Coding

With the 2024 CMS-HCC model, commonly referred to as V28, fully phased in for non-PACE Medicare Advantage organizations in 2026, HCC coding accuracy requires closer attention to documentation, diagnosis specificity, current mappings, and coding validation. The transition is more than a change in HCC numbers. Diagnosis-to-HCC mappings, condition categories, coefficients, and model logic have changed. […]

Accurate Hierarchical Condition Category (HCC) coding plays an important role in Medicare Advantage and other risk-based payment arrangements. In 2026, the 2024 CMS-HCC model, commonly referred to as V28, is fully phased in for non-PACE Medicare Advantage organizations, ending the multi-year transition from the previous model. This change affects diagnosis-to-HCC mappings, condition categories, model coefficients, […]