RxHCC Category |
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The table below contains a crosswalk of the ICD-10-CM codes that are included in the RxHCC Model v05 (2017, 2018, 2019, 2020, 2021, 2022) and v08 (2023 and 2024). It includes the RxHCC category descriptions, along with the associated prescription drug hierarchy.
| HCC Category Description | Disease Hierarchy | ICD-10-CM Codes | |
|---|---|---|---|
| 1 | HIV/AIDS | ... | |
| 5 | Opportunistic Infections | ... | |
| 15 | Chronic Myeloid Leukemia | 17, 18, 19, 20, 21, 22 | ... |
| 16 | Multiple Myeloma and Other Hematologic Cancers | 17, 18, 19, 20, 21, 22 | ... |
| 17 | Secondary Cancer of Bone and Kidney | 18, 19, 20, 21, 22 | ... |
| 18 | Secondary Cancer of Lung, Liver, Brain, and Other Sites | 19, 20, 21, 22 | ... |
| 19 | Leukemias and Other Hematologic Cancers | 20, 21, 22 | ... |
| 20 | Lung, Kidney, and Other Cancers; Secondary Cancer of Lymph Nodes and Other Sites | 21, 22 | ... |
| 21 | Lymphomas and Other Hematologic Cancers | 22 | ... |
| 22 | Prostate, Breast, Bladder, and Other Cancers and Tumors | ... | |
| 30 | Diabetes with Complications | 31 | ... |
| 31 | Diabetes without Complication | ... | |
| 40 | Alpha - 1 - Antitrypsin Deficiency | 43 | ... |
| 41 | Lysosomal Storage Disorders | 43 | ... |
| 42 | Acromegaly and Other Endocrine and Metabolic Disorders | 43 | ... |
| 43 | Pituitary, Adrenal Gland, and Other Endocrine and Metabolic Disorders | ... | |
| 44 | Thyroid Disorders | ... | |
| 47 | Disorders of Lipoid Metabolism | ... | |
| 54 | Chronic Viral Hepatitis C | 55 | ... |
| 55 | Acute or Unspecified Viral Hepatitis C | ... | |
| 56 | Chronic Viral Hepatitis B and Other Specified Chronic Viral Hepatitis | ... | |
| 59 | Primary Biliary Cirrhosis | ... | |
| 65 | Chronic Pancreatitis | 66 | ... |
| 66 | Pancreatic Disorders and Intestinal Malabsorption, Except Pancreatitis | ... | |
| 67 | Inflammatory Bowel Disease | ... | |
| 80 | Aseptic Necrosis of Bone | ... | |
| 81 | Psoriatic Arthropathy | 83, 84, 316 | ... |
| 82 | Systemic Sclerosis | 83, 84 | ... |
| 83 | Rheumatoid Arthritis and Other Inflammatory Polyarthropathy | 84 | ... |
| 84 | Systemic Lupus Erythematosus and Other Systemic Connective Tissue Disorders | 317 | ... |
| 87 | Osteoporosis, Vertebral and Pathological Fractures | ... | |
| 95 | Sickle Cell Anemia | ... | |
| 96 | Acquired Hemolytic, Aplastic, and Sideroblastic Anemias | ... | |
| 98 | Hereditary Angioedema and Other Defects in the Complement System | ... | |
| 99 | Immune Disorders | ... | |
| 100 | Immune Thrombocytopenic Purpura | ... | |
| 111 | Alzheimer's Disease | 112 | ... |
| 112 | Dementia, Except Alzheimer's Disease | ... | |
| 130 | Schizophrenia and Other Psychosis | 131, 132, 133 | ... |
| 131 | Bipolar Disorders | 132, 133 | ... |
| 132 | Depression | 133 | ... |
| 133 | Anxiety and Other Psychiatric Disorders | ... | |
| 146 | Profound or Severe Intellectual Disability/ Developmental Disorder | 147, 148 | ... |
| 147 | Moderate Intellectual Disability / Developmental Disorder | 148 | ... |
| 148 | Mild or Unspecified Intellectual Disability / Developmental Disorder | ... | |
| 153 | Myasthenia Gravis and Other Myoneural Disorders | ... | |
| 154 | Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease | ... | |
| 155 | Spinal Cord Disorders | ... | |
| 157 | Chronic Inflammatory Demyelinating Polyneuritis | 158 | ... |
| 158 | Inflammatory and Toxic Neuropathy | ... | |
| 159 | Multiple Sclerosis | ... | |
| 160 | Huntington Disease | ... | |
| 161 | Parkinson Disease | ... | |
| 163 | Intractable Epilepsy | 164 | ... |
| 164 | Epilepsy and Other Seizure Disorders, Except Intractable Epilepsy | ... | |
| 166 | Migraine Headaches | ... | |
| 168 | Trigeminal and Postherpetic Neuralgia | ... | |
| 183 | Pulmonary Arterial Hypertension | 184, 186, 187 | ... |
| 184 | Pulmonary Hypertension, Except Arterial, and Other Pulmonary Heart Disease | 186, 187 | ... |
| 186 | Heart Failure | 187 | ... |
| 187 | Hypertension | ... | |
| 188 | Coronary Artery Disease | ... | |
| 191 | Ventricular Septal Defect and Major Congenital Heart Disorders | ... | |
| 193 | Atrial Arrhythmias | ... | |
| 207 | Spastic Hemiplegia | ... | |
| 215 | Venous Thromboembolism | ... | |
| 225 | Cystic Fibrosis | 229 | ... |
| 226 | Idiopathic Pulmonary Fibrosis and Systemic Sclerosis with Lung Involvement | 227, 229 | ... |
| 227 | Pulmonary Fibrosis, Except Idiopathic | 229 | ... |
| 228 | Severe Persistent Asthma | 229 | ... |
| 229 | Chronic Obstructive Pulmonary Disease, Bronchiectasis, and Other Asthma | ... | |
| 243 | Glaucoma, Open - Angle or Moderate/ Severe Stage | 244 | ... |
| 244 | Other Non - Acute Glaucoma | ... | |
| 260 | Kidney Transplant Status | 261, 262, 263, 396 | ... |
| 261 | Dialysis Status, Including End Stage Renal Disease | 262, 263 | ... |
| 262 | Chronic Kidney Disease Stage 5 | 263 | ... |
| 263 | Chronic Kidney Disease Stage 4 | ... | |
| 311 | Chronic Ulcer of Skin, Except Pressure | ... | |
| 314 | Pemphigus, Pemphigoid, and Other Bullous Skin Disorders | ... | |
| 316 | Psoriasis, Except with Arthropathy | ... | |
| 317 | Discoid Lupus Erythematosus | ... | |
| 355 | Narcolepsy and Cataplexy | ... | |
| 395 | Stem Cell, Including Bone Marrow, Transplant Status/ Complications | ... | |
| 396 | Heart, Lung, Liver, Intestine, or Pancreas Transplant Status | ... |
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