RAF score calculator, built on verified V28 numbers.
Pick a member's age band and sex, check the documented conditions, and watch the CMS-HCC V28 risk score build in real time: demographic factor, HCC coefficients with hierarchies applied, disease interactions, and the payment HCC count factor. Every coefficient traces to a CMS Rate Announcement table cited at the bottom of this page.
Plain languageWhat a RAF score actually is.
A RAF (Risk Adjustment Factor) score is the multiplier CMS puts on a Medicare Advantage member's payment. A member scoring 1.0 is expected to cost the average. A member scoring 2.0 is expected to cost about twice the average, so the plan is paid about twice as much to care for them. The score is not a judgment call: it is an additive formula with published coefficients, and this page runs the real ones.
Three mechanics trip people up, and this calculator models all three. First, hierarchies: if a member has both CKD stage 4 and CKD stage 3, only stage 4 pays; the lower category is dropped. Second, interactions: certain combinations, like diabetes plus heart failure, add an extra coefficient on top of the individual HCCs. Third, count factors: a member with 5 or more payment HCCs gets an additional factor that grows with the count. Skip these and your RAF math is wrong in both directions.
The toolBuild a member's V28 RAF score.
Everything runs in your browser. Nothing you enter is stored or sent anywhere. Coefficients are the Community, NonDual, Aged (CNA) column of Table VIII-1 in the CY2024 Rate Announcement, the model CMS uses for 100 percent of payment year 2026 risk scores.
Demographics
Documented conditions (HCCs)
ICD-10 codes shown are common examples, not the full mapping list. The complete V28 code-to-HCC mappings are published in the CMS model software files linked in the sources below. If a selected condition is greyed out, a more severe HCC in the same hierarchy supersedes it and only the severe one pays.
Worked exampleOne member, every mechanic in play.
An 86-year-old woman with documented type 2 diabetes with chronic complications, morbid obesity, major depression, COPD, CKD stage 4, chronic heart failure, and atrial fibrillation. Eight codes go in; seven HCCs pay, because the diabetes hierarchy drops the less severe category.
| Component | Detail | Factor |
|---|---|---|
| Demographic | Female, 85 to 89, CNA segment | 0.624 |
| HCC 37 | Diabetes with chronic complications (HCC 38 documented too, dropped by hierarchy) | 0.166 |
| HCC 48 | Morbid obesity | 0.186 |
| HCC 155 | Major depression, moderate or severe | 0.299 |
| HCC 280 | COPD and other chronic lung disorders | 0.319 |
| HCC 327 | Chronic kidney disease, severe (stage 4) | 0.514 |
| HCC 226 | Heart failure, except end-stage and acute | 0.360 |
| HCC 238 | Specified heart arrhythmias (atrial fibrillation) | 0.299 |
| Interactions | Diabetes x HF (0.112) + HF x chronic lung (0.078) + HF x kidney (0.176) + HF x arrhythmias (0.077) | 0.443 |
| Count factor | 7 payment HCCs (D7) | 0.188 |
| Total RAF | Sum of all components | 3.398 |
At an illustrative $1, 000 per member per month base rate, this member's 3.398 RAF represents about $40, 776 per year of risk-adjusted revenue. If the chart had said only "diabetes" and "heart failure" with no other specificity, the score drops to 1.262 (demographic 0.624 + HCC 38 at 0.166 + HCC 226 at 0.360 + the 0.112 Diabetes x Heart Failure interaction, with no count factor at 2 payment HCCs), leaving roughly $25, 632 per member per year on the table. That is the RAF gap, and it compounds across every member of the panel.
The V28 shiftWhy 2026 scores feel lower.
Payment year 2026 is the first year risk scores are calculated on 100 percent V28, closing the three-year phase-in that started in 2024. The model was rebuilt: more categories, fewer paying codes, recalibrated weights. If your capture strategy was tuned for V24, this is the year the tide fully goes out.
Two playbooks and a practice page for the V28 era.
The V28 HCC Migration Playbook maps what moved between V24 and V28 and how to re-baseline capture. The V28 RAF Optimization Playbook covers the compliant-capture workflow: suspecting, point-of-care prompts, and coder QA. And AI for HCC coding shows how ASP-RCM runs chart-to-code review at 100 percent volume instead of samples.
SourcesEvery number, traced.
No coefficient on this page is estimated or interpolated. Each one is read directly from a CMS document. Where a factor could not be verified against a CMS table, it was excluded rather than approximated.
| What it verifies | CMS document | Year |
|---|---|---|
| All demographic factors, HCC coefficients, disease interactions, payment HCC count factors, and the $10, 402.34 denominator (CNA column) | Announcement of CY2024 MA Capitation Rates and Part C/D Payment Policies, Attachment VIII, Table VIII-1 · cms.gov | Apr 2023 |
| Disease hierarchies (which HCC drops which) | Same document, Table VIII-4 · cms.gov | Apr 2023 |
| PY2026 risk scores use 100 percent of the 2024 CMS-HCC model (V28) | Announcement of CY2026 MA Capitation Rates and Part C/D Payment Policies · cms.gov | Apr 2025 |
| ICD-10-CM to V28 HCC mappings (full list; examples on this page are illustrative) | CMS Risk Adjustment page: model software and mappings · cms.gov | Current |
FAQRAF scores, answered.
What is a RAF score?
How is a RAF score calculated under CMS-HCC V28?
What changed from V24 to V28?
Why does documentation drive the RAF score?
What does a 0.1 RAF gap cost?
Now run the same math on your whole panel.
This calculator scores one member at a time. ASP-RCM's HCC coding practice runs chart-level V28 review across your full population: recapture rates, suspect lists, coder QA at 100 percent volume, and a quantified RAF gap with the revenue attached. First look is free.