HL7 Terminology (THO)
5.0.0 - Publication World

This page is part of the HL7 Terminology (v5.0.0: Release) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

NamingSystem: CMS Hierarchical Condition Categories

Official URL: http://terminology.hl7.org/NamingSystem/cmshcc Version:
Active as of 2021-12-02 Responsible: Centers for Medicare & Medicaid Services Computable Name: CMSHCC

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.

Summary

Defining URLhttp://terminology.hl7.org/NamingSystem/cmshcc
NameCMSHCC
Statusactive
Definition

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.

PublisherCenters for Medicare & Medicaid Services

Identifiers

TypeValuePreferredPeriod
URIhttp://terminology.hl7.org/CodeSystem/cmshcctrue2021-12-02 --> (ongoing)

History

DateActionCustodianAuthorComment
2022-01-28createHTAJessica BotaAdd CMS Hierarchical Condition Categories per HTA; UP-268