HCC 79: Chronic Pancreatitis ICD-10-CM
CMS-HCC Category 79 (Chronic Pancreatitis) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.218 and 0.799 to a beneficiary's RAF score depending on the payment segment (0.357 for a community, non-dual, aged enrollee). 2 ICD-10-CM diagnosis codes map to HCC 79. It sits at the top of its hierarchy: no other condition category supersedes it.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.357 |
| Community, partial-benefit dual, aged | 0.444 |
| Community, full-benefit dual, aged | 0.525 |
| Community, non-dual, disabled | 0.574 |
| Community, partial-benefit dual, disabled | 0.709 |
| Community, full-benefit dual, disabled | 0.799 |
| Institutional | 0.218 |
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. HCC 79 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.
ICD-10-CM Codes That Map to HCC 79 2 codes
- K86.0 Alcohol-induced chronic pancreatitis from V24 HCC 34
- K86.1 Other chronic pancreatitis from V24 HCC 34
Every code above carries the full HCC 79 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 79
What is HCC 79 in the CMS-HCC model?
HCC 79 is CMS-HCC Category 79 (Chronic Pancreatitis) in the V28 risk adjustment model. It covers 2 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 79?
For payment year 2026, HCC 79 adds 0.357 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 0.218 to 0.799 across the seven payment segments shown above.
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.
