The Risk Adjustment Factor is the sum of a patient’s demographic coefficients and condition (HCC) coefficients under the CMS-HCC model. A RAF of 1.0 represents average expected cost; Medicare Advantage payment scales with it.

How do HCC hierarchies change the math?

Within a disease hierarchy only the most severe documented HCC counts. Document E11.22 (diabetes with CKD, HCC 37) and E11.9 (diabetes without complication, HCC 38) together and HCC 38 is superseded — it adds nothing. This calculator applies all 17 V28 hierarchy groups automatically.

Does this calculator include demographic factors?

No. It sums condition coefficients only. A payment RAF also includes age/sex demographic factors, disease and count interaction terms, the new-enrollee model where applicable, plus CMS normalization and coding-intensity adjustments.

Which population segment should I choose?

CNA (community, non-dual, aged) is the most common segment for Medicare Advantage members living in the community without Medicaid eligibility. Dual-eligible and institutional members use the other segments — the same HCC can carry a meaningfully different coefficient.

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RAF score calculator — CMS-HCC V28, PY2026

Paste a problem list. Each code maps to its V28 HCC, the 17 disease hierarchies decide what actually counts, and the PY2026 coefficients for your population segment are summed.

How the math works

Roughly 8,000 ICD-10-CM codes map into 115 V28 payment HCCs. Within each of the 17 disease hierarchies, only the most severe documented category counts — diabetes with chronic complications (HCC 37) supersedes diabetes without complication (HCC 38). Each surviving HCC contributes its segment-specific coefficient, and coefficients differ substantially between community, dual-eligible, and institutional populations.

Full V28 weight table — Community, non-dual, aged (CNA), PY2026

All 115 payment HCCs, heaviest first. Switch segments with the selector above.

HCC	Category	Coefficient
49	Specified Lysosomal Storage Disorders	9.256
111	Hemophilia, Male	4.639
17	Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic	4.209
195	Myasthenia Gravis with (Acute) Exacerbation	2.909
276	Lung Transplant Status/Complications	2.531
222	End-Stage Heart Failure	2.505
223	Heart Failure with Heart Assist Device/Artificial Heart	2.505
18	Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid	2.341
114	Common Variable and Combined Immunodeficiencies	2.262
379	Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone	1.965
19	Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers

FAQ

What is a RAF score?: The Risk Adjustment Factor is the sum of a patient’s demographic coefficients and condition (HCC) coefficients under the CMS-HCC model. A RAF of 1.0 represents average expected cost; Medicare Advantage payment scales with it.
How do HCC hierarchies change the math?: Within a disease hierarchy only the most severe documented HCC counts. Document E11.22 (diabetes with CKD, HCC 37) and E11.9 (diabetes without complication, HCC 38) together and HCC 38 is superseded — it adds nothing. This calculator applies all 17 V28 hierarchy groups automatically.
Does this calculator include demographic factors?: No. It sums condition coefficients only. A payment RAF also includes age/sex demographic factors, disease and count interaction terms, the new-enrollee model where applicable, plus CMS normalization and coding-intensity adjustments.
Which population segment should I choose?: CNA (community, non-dual, aged) is the most common segment for Medicare Advantage members living in the community without Medicaid eligibility. Dual-eligible and institutional members use the other segments — the same HCC can carry a meaningfully different coefficient.