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 (living at home, age 65 or over, not also enrolled in Medicaid). 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.
