The Centers for Medicare and Medicaid Services (CMS) announced the updates to the Risk Adjustment model for 2024 and there are some big changes coming.  The transition from the previous version (V24) to the new version (V28) includes changes to the hierarchical condition categories (HCCs), diagnoses that map to HCC categories and the coefficients for Risk Adjustment Factor (RAF) calculations.

The implementation of the V28 payment model will occur over three years with 100% of risk adjustment scores being calculated using the V28 model in 2026.

V24 includes 86 HCC categories and that will increase to 115 payment HCCs in V28 and the HCC categories have been renumbered.  Even though the number of HCC categories increased, over 2,000 diagnoses were removed from the payment model resulting in about 7,700 diagnosis codes that will map to a payment HCC.

One of the biggest noted changes from V24 to V28 is the “constraining” of coefficients, which means the HCC score is the same, for diabetes and congestive heart failure regardless of complexity or complications of those conditions.

Another big change is the removal of codes for protein calorie malnutrition, angina pectoris, and atherosclerosis of artery of extremity with intermittent claudication which no longer map to a payment HCC.

The biggest impacts to the HCC categories occurred in the HCCs for vascular disease, metabolic diseases, heart diseases, blood diseases, amputations, neurological diseases, diabetes, kidney diseases, psychiatric diseases, and musculoskeletal diseases.

Based on the extensive changes with the move from V24 to V28, it is important to familiarize yourself with the codes that may have been moved to different HCCs or removed from the payment model. Tune into our webinar to get the full update on these changes!

Looking for additional information on this topic?