HCC 64: Cirrhosis of Liver ICD-10-CM
CMS-HCC Category 64 (Cirrhosis of Liver) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.270 and 0.475 to a beneficiary's RAF score depending on the payment segment (0.447 for a community, non-dual, aged enrollee). 6 ICD-10-CM diagnosis codes map to HCC 64. A more severe related category (HCC 62 and HCC 63) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.447 |
| Community, partial-benefit dual, aged | 0.391 |
| Community, full-benefit dual, aged | 0.475 |
| Community, non-dual, disabled | 0.383 |
| Community, partial-benefit dual, disabled | 0.270 |
| Community, full-benefit dual, disabled | 0.414 |
| Institutional | 0.378 |
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) and HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders) supersede HCC 64 when reported together. HCC 64 in turn supersedes HCC 65 (Chronic Hepatitis) and HCC 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones).
ICD-10-CM Codes That Map to HCC 64 6 codes
- K70.30 Alcoholic cirrhosis of liver without ascites from V24 HCC 28
- K70.31 Alcoholic cirrhosis of liver with ascites from V24 HCC 28
- K71.7 Toxic liver disease with fibrosis and cirrhosis of liver new to V28
- K74.4 Secondary biliary cirrhosis from V24 HCC 28
- K74.60 Unspecified cirrhosis of liver from V24 HCC 28
- K74.69 Other cirrhosis of liver from V24 HCC 28
Every code above carries the full HCC 64 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 64
What is HCC 64 in the CMS-HCC model?
HCC 64 is CMS-HCC Category 64 (Cirrhosis of Liver) in the V28 risk adjustment model. It covers 6 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 64?
For payment year 2026, HCC 64 adds 0.447 to the RAF score of a community, non-dual, aged beneficiary (living at home, age 65 or over, not also enrolled in Medicaid). The published weights range from 0.270 to 0.475 across the seven payment segments shown above.
Which categories supersede HCC 64?
HCC 62 (Liver Transplant Status/Complications) and HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders) sit above HCC 64 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.
