Research

Findings about how the CMS-HCC risk adjustment model treats ICD-10-CM codes, recomputed directly from CMS's own model software.

Every figure on these pages carries the commands that produce it, run against two public CMS files. We would rather you checked than trusted us.

• FY2026 ICD-10-CM · CMS-HCC V28 PY2027 · COMMUNITY_NA

  Carcinoma in situ risk-adjusts at zero — all 59 codes, with one exception

  The Ca in situ column of the ICD-10-CM Neoplasm Table resolves to 59 distinct codes. Not one maps to a CMS-HCC V28 category.

• CMS-HCC V28 PY2027 · COMMUNITY_NA

  Two ICD-10 codes change HCC on the patient's sex, and the swing is 10×

  339 ICD-10 codes map to more than one CMS-HCC V28 category — 189 conditionally on age or sex, and 150 simultaneously. Hemophilia A and B swing 10.3× on sex alone.

Published by Eviora Health Tech LLC. These pages describe payment-model behaviour, not coding advice — code selection follows the ICD-10-CM Official Guidelines and the provider's documentation.