CMS-HCC Model V28: What It Means for Accurate Risk Adjustment

Persivia Inc12 Jul, 2025Health

Healthcare organizations need to understand risk adjustment changes fast. CMS-HCC Model V28 introduces major updates that directly influence how Medicare Advantage plans evaluate risk scores and receive payments from CMS. CMS HCC V28 is the latest version of the Hierarchical Condition Category model used by Medicare to calculate risk-adjusted payments. It replaced the previous V24 model and includes updated coefficient values, new condition categories, and refined clinical logic.