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Liver disease HCCs in CMS-HCC V28 (HCC 62-68)

The liver disease group of the CMS-HCC V28 model holds 5 payment categories (HCC 62, 63, 64, 65, 68): liver transplant, end-stage liver disease, cirrhosis, hepatitis and bile duct obstruction. 52 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.185 (HCC 65) to 0.962 (HCC 63). Inside the group, HCC 62 drops 63, 64, 65 and 68; HCC 63 drops 64, 65 and 68; HCC 64 drops 65 and 68. HCC 65 does not drop, and is not dropped by, HCC 68, so a member coded for both is paid for both unless a higher-ranked category is also documented.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); CMS-HCC V28 model software: CMS-HCC V28 software V2826.115.T2 (PY2027 initial) (payment year 2027). Next CMS release: PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027).

Payment categories
5
Mapped ICD-10-CM codes
52
Factor range (CNA)
0.185 to 0.962
Hierarchies in the group
1
CMS hierarchy group "Liver"

Categories and relative factors

Each factor is added to the member's demographic factors when the category is documented in the data collection year. Community, non-dual, aged (CNA) is the largest segment; the disabled (CND) and long-term institutional (INS) segments are estimated separately, which is why the same category is worth a different amount for each.

CMS-HCC V28 liver disease categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 62Liver Transplant Status/Complications70.3760.1840.593
HCC 63Chronic Liver Failure/End-Stage Liver Disorders140.9621.0320.894
HCC 64Cirrhosis of Liver60.4470.3830.378
HCC 65Chronic Hepatitis170.1850.2480.378
HCC 68Cholangitis and Obstruction of Bile Duct Without Gallstones80.3880.3830.090

Hierarchy inside the group

The V28 hierarchy macro ranks related categories so that a member with codes in several of them is paid only for the higher-ranked one. Each category drops only the categories its own macro entry lists.

HCC 62, 63, 64, 65, 68 do not form a single chain: the ranking branches, so each category's own drop list from the macro is shown instead.

  • HCC 62 (Liver Transplant Status/Complications) drops HCC 63, HCC 64, HCC 65 and HCC 68
  • HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders) drops HCC 64, HCC 65 and HCC 68
  • HCC 64 (Cirrhosis of Liver) drops HCC 65 and HCC 68

HCC 65 does not drop, and is not dropped by, HCC 68, so a member coded for both is paid for both unless a higher-ranked category is also documented.

The macro also ranks some of these categories against categories in other groups:

  • HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders) drops HCC 202 (Neurological)

ICD-10-CM code families

Where the mapped codes concentrate. A family with many codes is usually where specificity matters most: the category only counts when the documented diagnosis supports the exact code reported.

Three-character ICD-10-CM categories with the most codes in the liver disease group
ICD-10-CM categoryMapped codes
K706
B185
K715
K735
K745
T865
I854
K724

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. 13 codes in this group had no V24 payment category. The main V24 sources are below; the crosswalk report covers every category.

V24 categories behind the liver disease V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
27End-Stage Liver Disease13
29Chronic Hepatitis11
28Cirrhosis of Liver9
186Major Organ Transplant or Replacement Status7

The CMS-HCC V24 vs V28 crosswalk shows the codes that lost or gained payment status across all categories.

Inpatient MS-DRGs that use these diagnoses

Appendix B of the v44 MS-DRG Definitions Manual names the DRGs whose logic uses each diagnosis. The same documentation supports the inpatient group and, for Medicare Advantage members, the risk score.

MS-DRGs whose logic lists the most liver disease HCC codes
MS-DRGTitleShared codes
DRG 441Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis with MCC30
DRG 442Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis with CC30
DRG 443Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis without CC/MCC29
DRG 791Prematurity with Major Problems16
DRG 793Full Term Neonate with Major Problems16
DRG 432Cirrhosis and Alcoholic Hepatitis with MCC11
DRG 433Cirrhosis and Alcoholic Hepatitis with CC11
DRG 434Cirrhosis and Alcoholic Hepatitis without CC/MCC9

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted no code mapped to this group, so its code lists carry into FY2027 unchanged until CMS posts a mapping for the new code set. The FY2027 code changes report lists every new and deleted code.

Where QuickIntell fits for liver disease HCCs

An HCC counts only when the visit note supports it. QuickScribe captures the encounter documentation, and QuickCode supports qualified coder review and documentation clarification before diagnoses are submitted.

See QuickScribe for visit documentationSee QuickCode for coder reviewBook a meeting

Frequently asked questions

Which HCCs are in the V28 liver disease group?

HCC 62 (Liver Transplant Status/Complications, 7 codes, factor 0.376); HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders, 14 codes, factor 0.962); HCC 64 (Cirrhosis of Liver, 6 codes, factor 0.447); HCC 65 (Chronic Hepatitis, 17 codes, factor 0.185); HCC 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones, 8 codes, factor 0.388).

Which liver disease HCC has the most mapped ICD-10-CM codes?

HCC 65, Chronic Hepatitis, with 17 codes in the PY2027 initial mapping; across the group the largest code families are K70 (6), B18 (5), K71 (5), K73 (5).

Where did the liver disease codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 52 code-to-category links point to this group; 13 of those codes had no V24 payment category. The main V24 sources were HCC 27 (End-Stage Liver Disease, 13), HCC 29 (Chronic Hepatitis, 11), HCC 28 (Cirrhosis of Liver, 9).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Factors, hierarchies and mappings are reproduced from the CMS risk adjustment model files as an operational reference. The group is a navigation aid built from the V28 hierarchy; CMS pays categories, not groups. Payment depends on the plan's base rate, normalization, the coding intensity adjustment and the enrollee's segment. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.