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What is an HCC?
An HCC is a category of chronic medical conditions that share similar cost patterns.

For example, diabetes, chronic obstructive pulmonary disease (COPD), asthma and pulmonary disease, congestive heart failure, breast and prostate cancer, rheumatoid arthritis, and depressive disorder are all individual HCCs.

The model is hierarchical because many disease states have different levels of severity. For instance, diabetes with complications has a different HCC code than diabetes without complications. While patients may have multiple HCCs based on different manifestations of a disease, the model ensures that they will be assigned the HCC that reflects the most severe disease state. HCCs do not roll over to the next plan year and must be documented and re-submitted each year.

Because of COVID-19, CMS is allowing providers to use telehealth to conduct patient visits and submit their diagnoses, as long as the visit meets CMS guidelines for risk adjustment.

There are more than 86 HCC codes included in the 2020 CMS-HCC Risk Adjustment Model.