CMS proposed a model on 2023 diagnoses and 2024 expenditures and did not finalize it [2]; 1.079 comes from a four-year regression on 2022 to 2025 FFS risk scores [1].
| Input | CY 2027 | What it means at the chart |
|---|---|---|
| Risk model | 2024 CMS-HCC model continues | Same 115 payment categories and hierarchies you coded to in 2026 |
| Normalization factor | 1.079 | Every raw score is divided by 1.079 before payment |
| Coding pattern adjustment | 5.90 percent | Statutory minimum, unchanged from 2026 |
| Model revision and normalization | -1.12 percent of payment | Entirely the normalization update, since the model did not change |
| Sources of diagnoses | -1.53 percent of payment | Unlinked chart reviews and audio-only visits stop counting |
Nothing about mapping or specificity changes between 2026 and 2027 dates of service; the V28 coding reference stays current. Detail: recalibration insight.
Story 2
Story 3
The path
Every chronic HCC resets on January 1. The members whose 2025 HCCs have no 2026 face-to-face documentation yet, and no visit on the calendar, are the only part of the 2027 score you can still move.
No. CMS proposed a model recalibrated on 2023 diagnoses and 2024 expenditures and did not finalize it. Non-PACE plans continue on the 2024 CMS-HCC model for CY 2027; PACE organizations use a 50/50 blend of the 2024 and 2017 models.
For the 2024 CMS-HCC model it is 1.079, calculated with a four-year simple linear regression on average FFS risk scores from 2022 through 2025. The ESRD models have their own factors, listed in the Rate Announcement.
Linked chart review records still count, and unlinked ones may still be submitted, but their diagnoses are not used in the payment year 2027 risk score unless the enrollee switched from a different MA parent organization the prior year.
The CMS-HCC model is prospective: payment year 2027 risk scores are built only from diagnoses documented at eligible 2026 encounters. A condition documented in 2025 and not in 2026 contributes nothing to 2027.
Checked October 25, 2026. Rules change; confirm against the source before relying on them. CMS has said the RADV audit schedule is subject to change.
We match 2025 HCCs to 2026 encounters, hand your clinic the open list with a prompt per member, and a certified coder owns every code that follows.