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 $8,034.71.

Disease Coefficients	Description Label	Community Factor	Institutional Factor
HCC1	HIV/AIDS	0.492	1.374
HCC2	Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock	0.520	0.471
HCC6	Opportunistic Infections	0.557	0.541
HCC8	Metastatic Cancer and Acute Leukemia	2.425	0.928
HCC9	Lung and Other Severe Cancers	1.006	0.610
HCC10	Lymphoma and Other Cancers	0.695	0.363
HCC11	Colorectal, Bladder, and Other Cancers	0.330	0.255
HCC12	Breast, Prostate, and Other Cancers and Tumors	0.180	0.165
HCC17	Diabetes with Acute Complications	0.344	0.434
HCC18	Diabetes with Chronic Complications	0.344	0.434
HCC19	Diabetes without Complications	0.124	0.187
HCC21	Protein-Calorie Malnutrition	0.653	0.343
HCC22	Morbid Obesity	0.342	0.353
HCC23	Other Significant Endocrine and Metabolic Disorders	0.240	0.248
HCC27	End-Stage Liver Disease	1.003	0.637
HCC28	Cirrhosis of Liver	0.425	0.343
HCC29	Chronic Hepatitis	0.313	0.343
HCC33	Intestinal Obstruction/Perforation	0.337	0.302
HCC34	Chronic Pancreatitis	0.257	0.175
HCC35	Inflammatory Bowel Disease	0.279	0.250
HCC39	Bone/Joint/Muscle Infections/Necrosis	0.423	0.386
HCC40	Rheumatoid Arthritis and Inflammatory Connective Tissue Disease	0.376	0.222
HCC46	Severe Hematological Disorders	1.078	0.638
HCC47	Disorders of Immunity	0.306	0.436
HCC48	Coagulation Defects and Other Specific Hematological Disorders	0.258	0.197
HCC51	Dementia With Complications	0.616	-
HCC52	Dementia Without Complications	0.343	-
HCC54	Drug/Alcohol Psychosis	0.358	0.051
HCC55	Drug/Alcohol Dependence	0.358	0.051
HCC57	Schizophrenia	0.471	0.274
HCC58	Major Depressive, Bipolar, and Paranoid Disorders	0.318	0.274
HCC70	Quadriplegia	1.075	0.497
HCC71	Paraplegia	0.868	0.497
HCC72	Spinal Cord Disorders/Injuries	0.441	0.191
HCC73	Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease	1.016	0.294
HCC74	Cerebral Palsy	0.036	-
HCC75	Polyneuropathy	0.281	0.256
HCC76	Muscular Dystrophy	0.460	0.247
HCC77	Multiple Sclerosis	0.482	-
HCC78	Parkinson's and Huntington's Diseases	0.555	0.110
HCC79	Seizure Disorders and Convulsions	0.252	0.173
HCC80	Coma, Brain Compression/Anoxic Damage	0.533	0.103
HCC82	Respirator Dependence/Tracheostomy Status	1.732	1.567
HCC83	Respiratory Arrest	0.769	0.611
HCC84	Cardio-Respiratory Failure and Shock	0.326	0.346
HCC85	Congestive Heart Failure	0.361	0.226
HCC86	Acute Myocardial Infarction	0.283	0.394
HCC87	Unstable Angina and Other Acute Ischemic Heart Disease	0.283	0.394
HCC88	Angina Pectoris	0.210	0.366
HCC96	Specified Heart Arrhythmias	0.276	0.227
HCC99	Cerebral Hemorrhage	0.371	0.175
HCC100	Ischemic or Unspecified Stroke	0.333	0.175
HCC103	Hemiplegia/Hemiparesis	0.481	0.063
HCC104	Monoplegia, Other Paralytic Syndromes	0.212	0.063
HCC106	Atherosclerosis of the Extremities with Ulceration or Gangrene	1.313	0.773
HCC107	Vascular Disease with Complications	0.417	0.257
HCC108	Vascular Disease	0.288	0.146
HCC110	Cystic Fibrosis	0.388	0.323
HCC111	Chronic Obstructive Pulmonary Disease	0.388	0.323
HCC112	Fibrosis of Lung and Other Chronic Lung Disorders	0.294	0.252
HCC114	Aspiration and Specified Bacterial Pneumonias	0.006	0.610
HCC115	Pneumococcal Pneumonia, Emphysema, Lung Abscess	0.212	0.194
HCC122	Proliferative Diabetic Retinopathy and Vitreous Hemorrhage	0.223	0.366
HCC124	Exudative Macular Degeneration	0.248	0.178
HCC134	Dialysis Status	0.617	0.538
HCC135	Acute Renal Failure	0.617	0.538
HCC136	Chronic Kidney Disease, Stage 5	0.227	0.304
HCC137	Chronic Kidney Disease, Severe (Stage 4)	0.227	0.304
HCC138	Chronic Kidney Disease, Moderate (Stage 3)	0.227	0.304
HCC139	Chronic Kidney Disease, Mild or Unspecified (Stage 1-2 or Unspecified)	0.227	0.304
HCC140	Unspecified Renal Failure	0.227	0.304
HCC141	Nephritis	0.075	0.235
HCC157	Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone	1.071	0.284
HCC158	Pressure Ulcer of Skin with Full Thickness Skin Loss	1.071	0.284
HCC159	Pressure Ulcer of Skin with Partial Thickness Skin Loss	1.071	0.284
HCC160	Pressure Pre-Ulcer Skin Changes or Unspecified Stage	1.071`	0.610
HCC161	Chronic Ulcer of Skin, Except Pressure	0.473	0.226
HCC162	Severe Skin Burn or Condition	0.458	-
HCC166	Severe Head Injury	0.533	0.103
HCC167	Major Head Injury	0.141	-
HCC169	Vertebral Fractures without Spinal Cord Injury	0.441	0.179
HCC170	Hip Fracture/Dislocation	0.363	-
HCC173	Traumatic Amputation and Complications	0.379	0.067
HCC176	Complications of Specified Implanted Device or Graft	0.555	0.369
HCC186	Major Organ Transplant or Replacement Status	1.032	1.120
HCC188	Artificial Openings for Feeding or Elimination	0.609	0.658
HCC189	Amputation Status, Lower Limb / Amputation Complications	0.804	0.384