Hierarchical Condition Categories (HCC)

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You can search and see the HCC Categories here:

Hierarchical Condition Categories (HCC), are codes that are mapped to specific ICD 10 diagnoses. Since 2004, HCCs have been used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions. 

HCC coding depends on ICD-10-CM coding to assign risk scores to patients. Along with patients demographic factors such as age and gender, payers use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurance companies can use a patient’s RAF score to predict costs. 

ReLi Med Solutions provides the categories and their mappings to ICD10 codes. We however, do not calculate the Risk Adjustment Factors based on these mappings.