HL7 Terminology (THO)
5.5.0 - Publication International flag

This page is part of the HL7 Terminology (v5.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

CodeSystem: CMS Hierarchical Condition Categories

Official URL: http://terminology.hl7.org/CodeSystem/cmshcc Version: 1.1.0
Active as of 2024-01-26 Responsible: Centers for Medicare & Medicaid Services Computable Name: CMSHCC
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:oid:2.16.840.1.113883.6.349

The CMS-HCC model uses more than 9,000 ICD-10-CM codes, which are mapped to condition categories that predict costs well. The condition categories are based on diagnoses clinically related to one another and with similar predicted cost implications. Hierarchies are imposed on the condition categories to capture the most costly diagnoses. Hierarchy logic is imposed on certain condition categories to account for different hierarchical costs, thus, the term Hierarchical Condition Category, or HCC.

For more information, see https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.

The CMS HCCs are in the public domain and are free to use without restriction.

This Code system is referenced in the content logical definition of the following value sets:

  • This CodeSystem is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

This case-sensitive code system http://terminology.hl7.org/CodeSystem/cmshcc defines codes, but no codes are represented here


2024-03-02reviseHTAJessica BotaAdd OID for CMS Hierarchical Condition Categories; up-515
2022-07-22reviseTSMGJessica BotaAdd default value of TRUE for code systems missing caseSensitive element unless otherwise specified; UP-322
2022-01-28createHTAJessica BotaAdd CMS Hierarchical Condition Categories per HTA; UP-268