HCC 63: Chronic Liver Failure/End-Stage Liver Disorders ICD-10-CM
CMS-HCC Category 63 (Chronic Liver Failure/End-Stage Liver Disorders) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.861 and 1.209 to a beneficiary's RAF score depending on the payment segment (0.962 for a community, non-dual, aged enrollee). 14 ICD-10-CM diagnosis codes map to HCC 63. A more severe related category (HCC 62) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.962 |
| Community, partial-benefit dual, aged | 0.861 |
| Community, full-benefit dual, aged | 1.102 |
| Community, non-dual, disabled | 1.032 |
| Community, partial-benefit dual, disabled | 1.101 |
| Community, full-benefit dual, disabled | 1.209 |
| Institutional | 0.894 |
A beneficiary is scored in exactly one segment, set by Medicaid (dual) status, aged or disabled entitlement, and residence. Factors are relative weights, not dollar amounts; new-enrollee segments score on demographics only. In the hierarchy, HCC 62 (Liver Transplant Status/Complications) supersedes HCC 63 when reported together. HCC 63 in turn supersedes HCC 64 (Cirrhosis of Liver), HCC 65 (Chronic Hepatitis), HCC 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones), and HCC 202 (Coma, Brain Compression/Anoxic Damage).
ICD-10-CM Codes That Map to HCC 63 14 codes
- I85.00 Esophageal varices without bleeding from V24 HCC 27
- I85.01 Esophageal varices with bleeding from V24 HCC 27
- I85.10 Secondary esophageal varices without bleeding from V24 HCC 27
- I85.11 Secondary esophageal varices with bleeding from V24 HCC 27
- K70.40 Alcoholic hepatic failure without coma from V24 HCC 28
- K70.41 Alcoholic hepatic failure with coma from V24 HCC 27, HCC 28
- K72.10 Chronic hepatic failure without coma from V24 HCC 27
- K72.11 Chronic hepatic failure with coma from V24 HCC 27
- K72.90 Hepatic failure, unspecified without coma from V24 HCC 27
- K72.91 Hepatic failure, unspecified with coma from V24 HCC 27
- K76.6 Portal hypertension from V24 HCC 27
- K76.7 Hepatorenal syndrome from V24 HCC 27
- K76.81 Hepatopulmonary syndrome from V24 HCC 27
- K76.82 Hepatic encephalopathy from V24 HCC 27
Every code above carries the full HCC 63 weight when documented and reported on a Medicare Advantage encounter. The code link opens its full page with the complete risk adjustment card.
Questions About HCC 63
What is HCC 63 in the CMS-HCC model?
HCC 63 is CMS-HCC Category 63 (Chronic Liver Failure/End-Stage Liver Disorders) in the V28 risk adjustment model. It covers 14 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 63?
For payment year 2026, HCC 63 adds 0.962 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.861 to 1.209 across the seven payment segments shown above.
Which categories supersede HCC 63?
HCC 62 (Liver Transplant Status/Complications) sits above HCC 63 in the hierarchy: when a beneficiary has diagnoses in both, only the more severe category is paid.
Related References
Source: Centers for Medicare & Medicaid Services, Payment Year 2026 risk adjustment mapping and model software releases (CMS-HCC V28), applied to the FY 2026 ICD-10-CM code set. ICD List is not affiliated with CMS.
