Here is the short version. PY2026 is the year the CMS-HCC model finishes blending. Per the CY2026 Medicare Advantage and Part D Rate Announcement, risk scores now run on 100 percent V28 with zero V24 left in the weighted average. The two prior years cushioned the change. This one does not. If your capture strategy still leans on diabetes-with-complication tiers, peripheral vascular disease, or unspecified depression, the RAF you were carrying quietly walks out the door.
CMS did not flip to V28 overnight. The CY2024 Rate Announcement set a three-year glide path so plans and coders could adjust. Each year leaned harder on V28. The problem is that the softest impact was always front-loaded. The full weight of the remap lands now, when the transition closes.
V28 introduced in the CY2024 Rate Announcement. Most of your score still ran on the model you knew.
The CY2025 Rate Announcement tipped the majority onto V28. The remap started to show in scores.
The CY2026 Rate Announcement completes the transition. No blend left to soften a deleted or downweighted HCC.
Full impact, no cushionV28 did not trim every condition by the same fraction. It rewired specific families. Some HCCs were deleted from payment outright, some were remapped and downweighted, and a few were made more granular and held or gained. Read these top to bottom. The heaviest concentration sits in the first two layers.
Complication tiers carried distinct weight. "With chronic complications" and "with acute complications" paid above "without complications."
Diabetes collapses into a narrower set of HCCs with the tier separation largely flattened. The complication uplift you documented for is mostly gone from the payment signal.
Peripheral / atherosclerotic vascular disease (I70.x family) and angina pectoris (I20.x) mapped to a paying HCC.
Those codes are removed from the risk-adjustment mapping entirely. A chart full of well-documented atherosclerosis now returns nothing on this line.
Major depressive disorder, single episode, unspecified (F32.9) mapped to a paying HCC.
The unspecified single-episode code drops out. Recurrent and severe-with-specificity depression is retained, so the loss falls on under-specified documentation.
Mild and moderate malnutrition (E44.x) and unspecified (E46) contributed to a paying HCC.
The mild / moderate / unspecified tiers are removed. Severe malnutrition (E43) is retained, so specificity is the whole ballgame here.
Earlier CKD stages carried little to no payment weight; staging granularity was coarse.
CKD is renumbered and split more finely (including the stage-3 detail). This is the layer that can hold or improve if staging is documented precisely, and it partly offsets losses elsewhere.
Rebuild your ICD-10-to-HCC crosswalk against the V28 mapping on the FY2026 ICD-10-CM code set. Numbers moved; do not trust carried-forward tables.
Severe malnutrition, recurrent/severe depression, and precise CKD staging still pay. Query for the specificity V28 rewards instead of the volume V24 tolerated.
Peripheral vascular disease and angina no longer carry payment weight. Reforecast any RAF projection that still assumes they do.
Run last year's population through both models. The gap between V24 and 100 percent V28 is your real PY2026 exposure, by condition and by provider.
ASP-RCM Solutions runs risk adjustment inside CorePulse, our HCC engine, with de-identification enforced before anything reaches a model. We can dual-score your population under V24 and full V28, pinpoint where your RAF drop concentrates by condition and provider, and rebuild the capture playbook around what V28 still pays. No fabricated projections, just your charts through both models.
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