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. 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.
