Version 23 CMS-HCC Highlights

Your Comprehensive Guide to the CMS-HCC updates in version 23

Free Guide

 

Like all reporting structures, CMS updates its Hierarchical Condition Category (HCC) list each year. Recently, version 23 was released, and it contains some notable additions that CDI professionals—whether inpatient or outpatient—must be aware of.

 

The HCC model is a risk-adjustment methodology used for Medicare Advantage, population benchmarking for Accountable Care Organizations, and quality programs. In some cases, conditions that qualify for an HCC also count as CCs/MCCs in the MS-DRG system.

 

With version 23, CMS added several categories in the mental health area and one to the chronic kidney disease (CKD) grouping. While mental health may not be a common review focus for CDI professionals, capturing those conditions is paramount for accurate reporting and reimbursement.

 

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