HCC V28 is fully phased in for 2026. Here is what it does to your RAF.
The three-year transition is over. For payment year 2026, CMS scores 100 percent on the CMS-HCC V28 model. No more blended safety net from V24.
If your panel carried weight in diabetes, vascular disease, or depression, your 2026 RAF drops unless documentation and recapture change. V28 removed hundreds of codes from payment and flattened several high-volume conditions. The calculator below shows the swing on a real-looking member panel.
V28 is no longer partial. It is the whole score.
The blend that cushioned you for two years is retired.
CMS ran V28 in with a three-year phase-in so plans could adjust. Each year leaned harder on V28. In 2026 there is nothing left to lean on.
RAF calculator: V24 versus fully-phased V28 on one member panel.
Pick a member archetype or toggle conditions yourself. Watch the same panel score two ways. Red coefficients are the conditions that lost weight or fell off payment entirely under V28.
Same member. Two models. One score change.
// toggle conditions to rebuild the RAFCoefficients are illustrative, community non-dual aged, shown to demonstrate directional change. Exact factors live in the CMS-HCC V28 model files published with the CY2026 Rate Announcement. A demographic base of 0.436 and simple HCC-group hierarchy are applied; disease interactions are not modeled here.
V28 did not cut everything. It cut specific, high-volume things.
Lost weight or fell off payment DOCUMENT HARDER
- Diabetes - the without-complication and with-complication tiers were collapsed, so the old reward for coding complications shrank.
- Peripheral vascular disease and angina - several vascular and atherosclerosis codes were moved out of payment entirely.
- Major depression - the behavioral coefficient was reduced and lower-specificity depression codes lost payment.
- CKD stage 3 - early-stage renal weight was trimmed, pushing value toward accurate later-stage capture.
Held or strengthened PROTECT THESE
- Congestive heart failure - split into more granular acute and chronic HCCs; well-documented CHF holds its value.
- COPD - coefficient stayed roughly level, so annual recapture stays worth the effort.
- Morbid obesity - metabolic capture remains meaningful when BMI and comorbidity are documented.
- Protein-calorie malnutrition - still carries real weight, but the bar for clean documentation is higher.
The RxHCC model moved too.
Part D risk is scored on its own RxHCC model, also updated for 2026.
The CY2026 Rate Announcement carries an updated RxHCC model for Part D payment, separate from the CMS-HCC medical model. A member whose medical RAF slips under V28 can still carry meaningful RxHCC value, and the reverse is true. Plans that reconcile only the medical score leave Part D revenue on the table. Both models read from the same documentation, so one clean chart pass feeds both.
Know your V28 exposure before AWV season closes it out.
ASP-RCM Solutions re-scores your live panel on fully-phased V28, flags the members whose RAF fell under the new coefficients, and builds the recapture worklist that gets the documentable conditions back on the claim. Risk adjustment that is measured, not hoped for.
Model my 2026 V28 impact →Sources referenced: CY2026 Medicare Advantage and Part D Rate Announcement, the CMS-HCC risk adjustment model version 28 (V28), the prior CMS-HCC V24 (2020) model, and the RxHCC Part D model. Coefficients in the calculator are illustrative for demonstration; authoritative factors are in the CMS model files. No client data is shown.
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