HCC Risk Stratification Calculator

Estimate a patient’s CMS-HCC RAF (Risk Adjustment Factor) score and Medicare Advantage revenue impact based on Hierarchical Condition Categories and patient demographics. Uses approximate V28 model coefficients for educational purposes.

Patient Demographics

Demographic coefficient: 0.527

HCC Categories

RAF Score

0.527
Below Average Risk
01.0 avg2.04.0+
Demographic0.527
Total RAF0.527

Est. MA Revenue Impact

$5,797
estimated per member per year
$-5,203 vs average patient

Based on ~$11,000 national MA benchmark. Actual payment varies by county, plan type, and CMS rate book.

Select HCC categories from the list to add conditions to this score.

Demographic baseline only is shown above.

Educational use only. This calculator uses approximate CMS-HCC V28 community coefficients and a national average Medicare Advantage benchmark. Actual risk scores and payments depend on the specific MA plan, county benchmark, plan bid, and CMS reconciliation. HCC coding requires supporting clinical documentation. Do not report diagnoses that are not clinically supported.

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