Free tool
Free HCC lookup
Paste the diagnosis codes from a chart and see which ones risk-adjust: the CMS-HCC category each maps to, its coefficient, the age and sex edits that gate it, and which captured HCCs the hierarchy would zero because a higher one is present. No signup, no card, no email.
Free for up to 5 codes. We do not store what you paste, and please do not paste patient identifiers — we do not need them and do not want them.
What the answer means
- Maps to HCC n
- The code is on the CMS crosswalk for the model in force. The coefficient shown is what that category adds to a community, non-dual, aged beneficiary’s risk score on its own, before hierarchies and interactions.
- An age or sex edit
- Some mappings apply only to a patient in an age band or of one sex; a breast cancer code, for example, maps to different HCCs under and over fifty. The edit is printed so the answer is honest about depending on the patient.
- Captured, but would not score
- Two codes in the same hierarchy: the more severe category is paid and the other is zeroed. The code is not wrong and not wasted, and no further documentation for it will add score.
- Does not map
- Most ICD-10-CM codes are not in the model at all. Coding them correctly still matters for the claim; it just does not move the RAF.
Common questions
- What is an HCC?
- A Hierarchical Condition Category is a group of ICD-10-CM diagnoses that CMS treats as one condition for Medicare Advantage payment. Each HCC carries a coefficient; a beneficiary's risk adjustment factor is the sum of their demographic factor and the coefficients of the HCCs their documented diagnoses map to, after hierarchies and interactions.
- Which codes map to an HCC?
- Only a minority of ICD-10-CM codes do. CMS publishes the crosswalk each year; this lookup reads that crosswalk for the model in force, so an answer of 'does not map' means CMS does not risk-adjust that code, not that it is coded wrongly.
- Why did a code I captured not add anything?
- Usually a hierarchy. Within a disease family CMS pays only the most severe category present, so diabetes without complications is zeroed when diabetes with chronic complications is also documented. The lookup lists every captured HCC the hierarchy would suppress and names the HCC that outranks it.
- Is it really free?
- Yes. Up to 5 codes per lookup, with the mapping, the coefficient, the edits and the hierarchy, and no account. The paid workspace scores the whole chart as a RAF with the patient's age, sex, Medicaid and institutional status, the HCC count term and the disease interactions, and carries the same codes into the claim conflict check.
Every ICD-10-CM code page answers the HCC question for its one code, and the free claim scrubber checks the same diagnoses for Excludes1 conflicts and sequencing errors before they are submitted.