CMS-HCC Disease Coefficients

These are the disease coefficients component of the CMS-HCC Risk Adjustments

The relative risk scores in this table were calculated by dividing the parameter estimates by the Part C national average predicted expenditures (CMS Part C Denominator). The Part C Denominator value used is $9,276.26.

Disease Coefficients	Description Label	Community Factor	Institutional Factor
HCC1	HIV/AIDS	0.470	1.904
HCC2	Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock	0.535	0.575
HCC6	Opportunistic Infections	0.440	0.344
HCC8	Metastatic Cancer and Acute Leukemia	2.484	1.203
HCC9	Lung and Other Severe Cancers	0.973	0.674
HCC10	Lymphoma and Other Cancers	0.672	0.412
HCC11	Colorectal, Bladder, and Other Cancers	0.317	0.296
HCC12	Breast, Prostate, and Other Cancers and Tumors	0.154	0.198
HCC17	Diabetes with Acute Complications	0.368	0.474
HCC18	Diabetes with Chronic Complications	0.368	0.474
HCC19	Diabetes without Complications	0.118	0.182
HCC21	Protein-Calorie Malnutrition	0.713	0.399
HCC22	Morbid Obesity	0.365	0.579
HCC23	Other Significant Endocrine and Metabolic Disorders	0.245	0.282
HCC27	End-Stage Liver Disease	0.923	1.083
HCC28	Cirrhosis of Liver	0.399	0.351
HCC29	Chronic Hepatitis	0.251	0.351
HCC33	Intestinal Obstruction/Perforation	0.310	0.384
HCC34	Chronic Pancreatitis	0.286	0.095
HCC35	Inflammatory Bowel Disease	0.302	0.318
HCC39	Bone/Joint/Muscle Infections/Necrosis	0.498	0.340
HCC40	Rheumatoid Arthritis and Inflammatory Connective Tissue Disease	0.374	0.351
HCC46	Severe Hematological Disorders	1.136	0.794
HCC47	Disorders of Immunity	0.521	0.519
HCC48	Coagulation Defects and Other Specific Hematological Disorders	0.252	0.164
HCC54	Drug/Alcohol Psychosis	0.420	0.053
HCC55	Drug/Alcohol Dependence	0.420	0.053
HCC57	Schizophrenia	0.490	0.311
HCC58	Major Depressive, Bipolar, and Paranoid Disorders	0.330	0.311
HCC70	Quadriplegia	1.234	0.650
HCC71	Paraplegia	1.052	0.539
HCC72	Spinal Cord Disorders/Injuries	0.509	0.280
HCC73	Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease	0.958	0.367
HCC74	Cerebral Palsy	0.045	-
HCC75	Polyneuropathy	0.408	0.300
HCC76	Muscular Dystrophy	0.565	0.215
HCC77	Multiple Sclerosis	0.556	-
HCC78	Parkinson's and Huntington's Diseases	0.691	0.173
HCC79	Seizure Disorders and Convulsions	0.284	0.144
HCC80	Coma, Brain Compression/Anoxic Damage	0.570	0.104
HCC82	Respirator Dependence/Tracheostomy Status	1.520	1.769
HCC83	Respiratory Arrest	0.802	1.169
HCC84	Cardio-Respiratory Failure and Shock	0.329	0.442
HCC85	Congestive Heart Failure	0.368	0.229
HCC86	Acute Myocardial Infarction	0.275	0.515
HCC87	Unstable Angina and Other Acute Ischemic Heart Disease	0.258	0.515
HCC88	Angina Pectoris	0.141	0.474
HCC96	Specified Heart Arrhythmias	0.295	0.262
HCC99	Cerebral Hemorrhage	0.339	0.216
HCC100	Ischemic or Unspecified Stroke	0.317	0.216
HCC103	Hemiplegia/Hemiparesis	0.581	0.061
HCC104	Monoplegia, Other Paralytic Syndromes	0.396	0.061
HCC106	Atherosclerosis of the Extremities with Ulceration or Gangrene	1.413	0.886
HCC107	Vascular Disease with Complications	0.410	0.301
HCC108	Vascular Disease	0.299	0.107
HCC110	Cystic Fibrosis	0.417	0.364
HCC111	Chronic Obstructive Pulmonary Disease	0.346	0.364
HCC112	Fibrosis of Lung and Other Chronic Lung Disorders	0.274	0.260
HCC114	Aspiration and Specified Bacterial Pneumonias	0.672	0.285
HCC115	Pneumococcal Pneumonia, Emphysema, Lung Abscess	0.200	0.285
HCC122	Proliferative Diabetic Retinopathy and Vitreous Hemorrhage	0.203	0.433
HCC124	Exudative Macular Degeneration	0.335	0.166
HCC134	Dialysis Status	0.476	0.509
HCC135	Acute Renal Failure	0.476	0.509
HCC136	Chronic Kidney Disease, Stage 5	0.224	0.509
HCC137	Chronic Kidney Disease, Severe (Stage 4)	0.224	0.294
HCC157	Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone	2.488	1.050
HCC158	Pressure Ulcer of Skin with Full Thickness Skin Loss	1.338	0.435
HCC161	Chronic Ulcer of Skin, Except Pressure	0.536	0.311
HCC162	Severe Skin Burn or Condition	0.411	0.327
HCC166	Severe Head Injury	0.570	0.104
HCC167	Major Head Injury	0.163	-
HCC169	Vertebral Fractures without Spinal Cord Injury	0.497	0.228
HCC170	Hip Fracture/Dislocation	0.446	-
HCC173	Traumatic Amputation and Complications	0.265	0.122
HCC176	Complications of Specified Implanted Device or Graft	0.556	0.522
HCC186	Major Organ Transplant or Replacement Status	0.891	0.515
HCC188	Artificial Openings for Feeding or Elimination	0.651	0.594
HCC189	Amputation Status, Lower Limb / Amputation Complications	0.779	0.468