HL7 Terminology (THO)
6.1.0 - Publication International flag

This page is part of the HL7 Terminology (v6.1.0: Release) based on FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions

: CMS Hierarchical Condition Categories - JSON Representation

Active as of 2024-01-26

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{
  "resourceType" : "NamingSystem",
  "id" : "cmshcc",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: NamingSystem cmshcc</b></p><a name=\"cmshcc\"> </a><a name=\"hccmshcc\"> </a><a name=\"cmshcc-en-US\"> </a><h3>Summary</h3><table class=\"grid\"><tr><td>Defining URL</td><td>http://terminology.hl7.org/NamingSystem/cmshcc</td></tr><tr><td>Version</td><td>1.1.0</td></tr><tr><td>Name</td><td>CMSHCC</td></tr><tr><td>Title</td><td>CMS Hierarchical Condition Categories</td></tr><tr><td>Status</td><td>active</td></tr><tr><td>Definition</td><td><div><p>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.</p>\n<p>For more information, see https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.</p>\n<p>The CMS HCCs are in the public domain and are free to use without restriction.</p>\n</div></td></tr><tr><td>Publisher</td><td>Centers for Medicare &amp; Medicaid Services</td></tr></table><h3>Identifiers</h3><table class=\"grid\"><tr><td><b>Type</b></td><td><b>Value</b></td><td><b>Preferred</b></td><td><b>Period</b></td></tr><tr><td>URI</td><td>http://terminology.hl7.org/CodeSystem/cmshcc</td><td>true</td><td>2021-12-02 --&gt; (ongoing)</td></tr><tr><td>OID</td><td>2.16.840.1.113883.6.349</td><td>true</td><td></td></tr></table></div>"
  },
  "url" : "http://terminology.hl7.org/NamingSystem/cmshcc",
  "version" : "1.1.0",
  "name" : "CMSHCC",
  "title" : "CMS Hierarchical Condition Categories",
  "status" : "active",
  "kind" : "codesystem",
  "date" : "2024-01-26T00:00:00-00:00",
  "publisher" : "Centers for Medicare & Medicaid Services",
  "responsible" : "Centers for Medicare & Medicaid Services",
  "description" : "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.\r\n\r\nFor more information, see https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.\r\n\r\nThe CMS HCCs are in the public domain and are free to use without restriction.",
  "uniqueId" : [
    {
      "type" : "uri",
      "value" : "http://terminology.hl7.org/CodeSystem/cmshcc",
      "preferred" : true,
      "period" : {
        "start" : "2021-12-02"
      }
    },
    {
      "type" : "oid",
      "value" : "2.16.840.1.113883.6.349",
      "preferred" : true
    }
  ]
}