ViewBag.Title

CMS-HCC Disease Coefficient

 Risk Adjustment Search Tool
HCC Category
Demographic Coefficient
Back to HCC Risk Adjustment

The table below shows HCC coefficients for the HCCs defined in the risk adjustment model in the specified payment year. CMS-HCC risk adjustment models are applied to the community non-dual aged, community non-dual disabled, community full benefit dual aged, community full benefit dual disabled, community partial benefit dual aged, community partial benefit dual disabled, and institutional.

HCC Category Description Community, NonDual, Aged Community, NonDual, Disabled Community, FBDual, Aged Community, FBDual, Disabled Community, PBDual, Aged Community, PBDual, Disabled Institutional
1 HIV/AIDS 0.301 0.213 0.397 0.237 0.196 0.109 1.322
2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock 0.500 0.598 0.649 0.780 0.447 0.591 0.605
6 Opportunistic Infections 0.381 0.763 0.588 0.833 0.518 0.685 0.728
17 Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic 4.209 3.995 3.896 4.235 3.946 4.103 1.952
18 Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid 2.341 2.486 2.277 2.537 2.166 2.403 1.110
19 Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers 1.798 1.989 1.563 1.661 1.520 1.554 0.957
20 Lung and Other Severe Cancers 1.136 0.978 1.166 1.173 1.214 1.067 0.672
21 Lymphoma and Other Cancers 0.671 0.540 0.654 0.739 0.627 0.618 0.493
22 Bladder, Colorectal, and Other Cancers 0.363 0.366 0.382 0.409 0.410 0.351 0.314
23 Prostate, Breast, and Other Cancers and Tumors 0.186 0.233 0.196 0.218 0.203 0.237 0.197
35 Pancreas Transplant Status 0.949 1.393 1.117 0.573 1.117 2.740 1.106
36 Diabetes with Severe Acute Complications 0.166 0.191 0.186 0.235 0.166 0.210 0.280
37 Diabetes with Chronic Complications 0.166 0.191 0.186 0.235 0.166 0.210 0.280
38 Diabetes with Glycemic, Unspecified, or No Complications 0.166 0.191 0.186 0.235 0.166 0.210 0.280
48 Morbid Obesity 0.186 0.144 0.300 0.178 0.164 0.118 0.442
49 Specified Lysosomal Storage Disorders 9.256 13.778 2.833 6.399 3.269 7.771 1.528
50 Amyloidosis, Porphyria, and Other Specified Metabolic Disorders 0.648 0.883 0.555 0.789 0.435 0.529 0.362
51 Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders 0.510 0.606 0.634 0.654 0.313 0.393 0.620
62 Liver Transplant Status/Complications 0.376 0.184 0.261 0.409 0.571 0.271 0.593
63 Chronic Liver Failure/End-Stage Liver Disorders 0.962 1.032 1.102 1.209 0.861 1.101 0.894
64 Cirrhosis of Liver 0.447 0.383 0.475 0.414 0.391 0.270 0.378
65 Chronic Hepatitis 0.185 0.248 0.101 0.220 0.156 0.189 0.378
68 Cholangitis and Obstruction of Bile Duct Without Gallstones 0.388 0.383 0.085 0.354 0.391 0.270 0.090
77 Intestine Transplant Status/Complications 1.172 6.301 5.039 6.161 5.039 5.039 5.089
78 Intestinal Obstruction/Perforation 0.326 0.534 0.382 0.548 0.478 0.688 0.380
79 Chronic Pancreatitis 0.357 0.574 0.525 0.799 0.444 0.709 0.218
80 Crohn's Disease (Regional Enteritis) 0.550 0.635 0.490 0.651 0.479 0.603 0.374
81 Ulcerative Colitis 0.244 0.285 0.201 0.286 0.205 0.237 0.258
92 Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis 0.479 0.529 0.611 0.632 0.471 0.539 0.556
93 Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders 0.617 0.470 0.439 0.384 0.405 0.288 0.297
94 Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders 0.268 0.239 0.237 0.250 0.224 0.196 0.297
107 Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero 0.457 1.449 0.610 1.939 0.303 1.569 0.692
108 Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major 0.146 0.386 0.103 0.408 0.303 0.416 0.098
109 Acquired Hemolytic, Aplastic, and Sideroblastic Anemias 1.144 1.815 1.048 1.541 1.009 1.514 0.529
111 Hemophilia, Male 4.639 30.706 15.539 31.424 11.201 32.199 6.310
112 Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions 0.450 0.640 0.460 0.634 0.574 0.708 0.516
114 Common Variable and Combined Immunodeficiencies 2.262 2.598 2.016 2.670 2.137 2.789 0.691
115 Specified Immunodeficiencies and White Blood Cell Disorders 0.565 0.692 0.438 0.498 0.302 0.613 0.691
125 Dementia, Severe 0.341 0.296 0.438 0.367 0.401 0.345 0.000
126 Dementia, Moderate 0.341 0.296 0.438 0.367 0.401 0.345 0.000
127 Dementia, Mild or Unspecified 0.341 0.296 0.438 0.367 0.401 0.345 0.000
135 Drug Use with Psychotic Complications 0.424 0.637 0.702 1.181 0.522 0.922 0.297
136 Alcohol Use with Psychotic Complications 0.424 0.637 0.502 1.181 0.522 0.922 0.297
137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications 0.424 0.365 0.502 0.471 0.394 0.348 0.297
138 Drug Use Disorder, Mild, Uncomplicated, Except Cannabis 0.423 0.264 0.502 0.384 0.355 0.348 0.297
139 Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications 0.242 0.207 0.478 0.250 0.308 0.159 0.000
151 Schizophrenia 0.511 0.380 0.591 0.414 0.501 0.304 0.449
152 Psychosis, Except Schizophrenia 0.484 0.290 0.579 0.255 0.501 0.247 0.208
153 Personality Disorders; Anorexia/Bulimia Nervosa 0.396 0.290 0.420 0.255 0.464 0.232 0.199
154 Bipolar Disorders without Psychosis 0.351 0.166 0.349 0.126 0.314 0.108 0.199
155 Major Depression, Moderate or Severe, without Psychosis 0.299 0.166 0.316 0.126 0.269 0.108 0.199
180 Quadriplegia 1.125 0.986 1.068 1.095 1.311 1.399 0.735
181 Paraplegia 0.942 0.648 0.859 0.832 0.883 0.852 0.563
182 Spinal Cord Disorders/Injuries 0.478 0.368 0.402 0.308 0.401 0.316 0.270
190 Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease, Spinal Muscular Atrophy 1.175 1.792 1.427 3.642 0.640 1.243 0.628
191 Quadriplegic Cerebral Palsy 0.855 0.743 0.393 0.466 0.840 0.104 0.000
192 Cerebral Palsy, Except Quadriplegic 0.314 0.129 0.000 0.067 0.220 0.104 0.000
193 Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy 1.692 1.427 0.957 0.939 1.149 0.850 0.913
195 Myasthenia Gravis with (Acute) Exacerbation 2.909 3.633 2.153 3.323 2.690 1.779 1.837
196 Myasthenia Gravis without (Acute) Exacerbation and Other Myoneural Disorders 0.516 0.642 0.503 0.507 0.427 0.248 0.486
197 Muscular Dystrophy 0.426 0.632 0.369 0.681 0.162 0.145 0.292
198 Multiple Sclerosis 0.647 0.908 0.791 1.143 0.569 0.770 0.226
199 Parkinson and Other Degenerative Disease of Basal Ganglia 0.615 0.517 0.634 0.504 0.474 0.354 0.219
200 Friedreich and Other Hereditary Ataxias; Huntington Disease 0.279 0.208 0.165 0.281 0.050 0.428 0.000
201 Seizure Disorders and Convulsions 0.245 0.196 0.233 0.170 0.245 0.202 0.131
202 Coma, Brain Compression/Anoxic Damage 0.543 0.238 0.721 0.279 0.549 0.309 0.097
211 Respirator Dependence/Tracheostomy Status/Complications 0.879 0.878 1.981 1.418 1.022 0.590 1.570
212 Respiratory Arrest 0.370 0.510 0.573 0.662 0.409 0.493 0.258
213 Cardio-Respiratory Failure and Shock 0.370 0.510 0.573 0.662 0.409 0.493 0.258
221 Heart Transplant Status/Complications 1.053 0.999 1.412 1.781 0.880 1.371 0.840
222 End-Stage Heart Failure 2.505 5.770 2.927 6.612 3.009 6.106 0.826
223 Heart Failure with Heart Assist Device/Artificial Heart 2.505 5.770 2.927 6.612 3.009 6.106 0.826
224 Acute on Chronic Heart Failure 0.360 0.442 0.406 0.537 0.311 0.411 0.217
225 Acute Heart Failure (Excludes Acute on Chronic) 0.360 0.442 0.406 0.537 0.311 0.411 0.217
226 Heart Failure, Except End-Stage and Acute 0.360 0.442 0.406 0.537 0.311 0.411 0.217
227 Cardiomyopathy/Myocarditis 0.189 0.200 0.173 0.198 0.145 0.186 0.189
228 Acute Myocardial Infarction 0.252 0.254 0.493 0.517 0.324 0.407 0.310
229 Unstable Angina and Other Acute Ischemic Heart Disease 0.240 0.254 0.325 0.458 0.278 0.315 0.310
238 Specified Heart Arrhythmias 0.299 0.296 0.407 0.304 0.293 0.261 0.245
248 Intracranial Hemorrhage 0.239 0.180 0.377 0.332 0.313 0.183 0.081
249 Ischemic or Unspecified Stroke 0.239 0.180 0.377 0.277 0.299 0.172 0.081
253 Hemiplegia/Hemiparesis 0.387 0.320 0.437 0.390 0.437 0.403 0.000
254 Monoplegia, Other Paralytic Syndromes 0.321 0.172 0.292 0.365 0.290 0.335 0.000
263 Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene 1.118 1.066 1.432 1.276 1.007 1.056 0.696
264 Vascular Disease with Complications 0.455 0.520 0.498 0.461 0.513 0.622 0.338
267 Deep Vein Thrombosis and Pulmonary Embolism 0.294 0.431 0.445 0.568 0.338 0.498 0.245
276 Lung Transplant Status/Complications 2.531 1.583 2.210 2.292 2.961 1.277 3.085
277 Cystic Fibrosis 0.998 2.818 1.340 3.760 0.650 3.829 0.873
278 Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis 0.818 1.209 0.791 1.640 0.650 0.937 0.873
279 Severe Persistent Asthma 0.818 0.842 0.594 0.808 0.650 0.804 0.873
280 Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders 0.319 0.209 0.390 0.281 0.321 0.234 0.312
282 Aspiration and Specified Bacterial Pneumonias 0.440 0.362 0.538 0.269 0.409 0.173 0.353
283 Empyema, Lung Abscess 0.204 0.000 0.131 0.074 0.000 0.000 0.000
298 Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage 0.336 0.364 0.323 0.319 0.327 0.301 0.545
300 Exudative Macular Degeneration 0.596 0.366 0.370 0.255 0.459 0.380 0.196
326 Chronic Kidney Disease, Stage 5 0.815 0.927 0.985 0.946 0.965 1.050 0.958
327 Chronic Kidney Disease, Severe (Stage 4) 0.514 0.523 0.565 0.661 0.484 0.447 0.462
328 Chronic Kidney Disease, Moderate (Stage 3B) 0.127 0.179 0.116 0.181 0.140 0.178 0.145
329 Chronic Kidney Disease, Moderate (Stage 3, Except 3B) 0.127 0.179 0.116 0.181 0.140 0.178 0.145
379 Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone 1.965 2.140 2.580 2.570 2.349 2.349 1.420
380 Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle 1.078 1.091 1.422 1.285 1.268 1.378 0.839
381 Pressure Ulcer of Skin with Full Thickness Skin Loss 1.075 1.091 1.379 1.192 1.136 1.089 0.423
382 Pressure Ulcer of Skin with Partial Thickness Skin Loss 0.838 0.994 1.029 0.935 0.845 0.937 0.343
383 Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle 0.646 0.707 0.890 0.707 0.660 0.654 0.343
385 Severe Skin Burn 1.291 0.234 2.362 0.857 0.000 0.204 0.000
387 Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders 0.406 0.302 0.658 0.622 0.477 0.498 0.125
397 Major Head Injury with Loss of Consciousness > 1 Hour 0.199 0.150 0.349 0.190 0.128 0.052 0.085
398 Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified 0.199 0.150 0.349 0.190 0.128 0.052 0.085
399 Major Head Injury without Loss of Consciousness 0.199 0.150 0.349 0.190 0.128 0.052 0.085
401 Vertebral Fractures without Spinal Cord Injury 0.522 0.605 0.622 0.559 0.538 0.412 0.231
402 Hip Fracture/Dislocation 0.467 0.561 0.561 0.570 0.499 0.527 0.089
405 Traumatic Amputations and Complications 0.598 0.577 0.799 0.844 0.639 0.698 0.284
409 Amputation Status, Lower Limb/Amputation Complications 0.598 0.562 0.799 0.844 0.604 0.623 0.284
454 Stem Cell, Including Bone Marrow, Transplant Status/Complications 1.068 0.452 1.326 0.608 1.338 0.416 1.596
463 Artificial Openings for Feeding or Elimination 0.673 0.914 0.891 0.947 0.526 0.853 0.634

Risk Adjustment Search Tool  |  HCC Category  |  Demographic Coefficient  |  Back to HCC Risk Adjustment