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 HCC 79 neither supersedes nor is superseded by any other category, so it always counts alongside unrelated HCCs.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. 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.
