HCC 65: Chronic Hepatitis ICD-10-CM
CMS-HCC Category 65 (Chronic Hepatitis) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.101 and 0.378 to a beneficiary's RAF score depending on the payment segment (0.185 for a community, non-dual, aged enrollee). 17 ICD-10-CM diagnosis codes map to HCC 65. A more severe related category (HCC 62, HCC 63, and HCC 64) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.185 |
| Community, partial-benefit dual, aged | 0.156 |
| Community, full-benefit dual, aged | 0.101 |
| Community, non-dual, disabled | 0.248 |
| Community, partial-benefit dual, disabled | 0.189 |
| Community, full-benefit dual, disabled | 0.220 |
| 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), HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders), and HCC 64 (Cirrhosis of Liver) supersede HCC 65 when reported together.
ICD-10-CM Codes That Map to HCC 65 17 codes
- B18.0 Chronic viral hepatitis B with delta-agent from V24 HCC 29
- B18.1 Chronic viral hepatitis B without delta-agent from V24 HCC 29
- B18.2 Chronic viral hepatitis C from V24 HCC 29
- B18.8 Other chronic viral hepatitis from V24 HCC 29
- B18.9 Chronic viral hepatitis, unspecified from V24 HCC 29
- K70.10 Alcoholic hepatitis without ascites new to V28
- K70.11 Alcoholic hepatitis with ascites new to V28
- K71.3 Toxic liver disease with chronic persistent hepatitis new to V28
- K71.4 Toxic liver disease with chronic lobular hepatitis new to V28
- K71.50 Toxic liver disease with chronic active hepatitis without ascites new to V28
- K71.51 Toxic liver disease with chronic active hepatitis with ascites new to V28
- K73.0 Chronic persistent hepatitis, not elsewhere classified from V24 HCC 29
- K73.1 Chronic lobular hepatitis, not elsewhere classified from V24 HCC 29
- K73.2 Chronic active hepatitis, not elsewhere classified from V24 HCC 29
- K73.8 Other chronic hepatitis, not elsewhere classified from V24 HCC 29
- K73.9 Chronic hepatitis, unspecified from V24 HCC 29
- K75.4 Autoimmune hepatitis from V24 HCC 29
Every code above carries the full HCC 65 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 65
What is HCC 65 in the CMS-HCC model?
HCC 65 is CMS-HCC Category 65 (Chronic Hepatitis) in the V28 risk adjustment model. It covers 17 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 65?
For payment year 2026, HCC 65 adds 0.185 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.101 to 0.378 across the seven payment segments shown above.
Which categories supersede HCC 65?
HCC 62 (Liver Transplant Status/Complications), HCC 63 (Chronic Liver Failure/End-Stage Liver Disorders), and HCC 64 (Cirrhosis of Liver) sit above HCC 65 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.
