Da Vinci Risk Adjustment Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 3.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ra/ and changes regularly. See the Directory of published versions

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ValueSet: Sample CMS Hierarchical Condition Category

Official URL: http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc				Version: 3.0.0-ballot	Highlight text changes?
Standards status: Trial-use Active as of 2026-03-19				Maturity Level: 2	Computable Name: SampleCMSHCC
Other Identifiers: OID:2.16.840.1.113883.4.642.40.29.48.7
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

This is a sample of the concepts that can be found in the CMS Hierarchical Condition Categories (CMS-HCC) code system version 24. The source of the codes included in this example was published at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2020.pdf. The CMS-HCC model uses more than 9,000 ICD-10-CM codes, which are mapped to condition categories (CCs) that predict costs well. The condition categories (CCs) are based on diagnoses clinically related to one another and with similar predicted cost implications. Hierarchies are imposed on the Condition Categories (CCs) to capture the most costly diagnoses. Hierarchy logic is imposed on certain Condition Categories (CCs) to account for different hierarchical costs, thus, the term Hierarchical Condition Category, or HCC.

References

• Risk Adjustment Data Exchange MeasureReport
• Risk Adjustment Data Exchange MeasureReport
• Risk Adjustment Coding Gap MeasureReport
• Risk Adjustment Coding Gap MeasureReport

Logical Definition (CLD)

 

Expansion

No Expansion for this valueset (Unknown Code System)

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Description of the above table(s).