V28 Model info

CMS final rate notice and call letter for payment year 2024

The establishment of CMS-hierarchical condition category (HCC) Version 28 (V28) has brought significant changes to the dynamic environment of health care reimbursement. To help practitioners adapt and succeed in continuous documentation improvement (CDI) efforts, we recommend referencing this document. It is crucial to understand the reclassification material below.

Please review the linked summary of the CMS final rate announcement for Medicare Advantage and Medicare Part D for payment year 2024. Changes in the V28 model (2024) include:

115 HCCs in the V28 model (2024) compared to 86 HCCs in the V24 model (2020). Hierarchies are still applied, but only the most serious condition category is counted within an HCC group of like conditions (e.g., diabetes with complications)
Alternative payment condition count (APCC) applies when a patient has 5 or more payable HCCs after the hierarchies are applied, and additional resources are allocated for their care.
For providers The V28 model will be a blended model, phased in over 3 years. Currently V28 model is active and will be applied 100% for 2025 dates of service (DOS).
- DOS 2023 - 67% V24 model, 33% V28 model
- DOS 2024 - 33% V24 model, 67% V28 model
- DOS 2025 - 100% V28 model
209 diagnoses are being added to the 2024 model, and 2,027 are being removed from the model.
- Diagnosis categories being added include:
  - Benign carcinoid tumors, codes D3A.0-D3A.8
  - Alcoholic hepatitis and toxic liver disease, codes K70.10, K70.11, K71.3, K71.4, K71.50, K71.51, K71.7
  - Congenital absence and malformations, codes Q40.0, Q41.-, Q42.-, Q43.1, Q43.2, Q43.3, Q44.2, Q44.3
  - Anorexia and bulimia, codes F50.00, F50.01, F50.02. F50.2
  - Severe persistent asthma, codes J45.50, J45.51, J45.52
  - Presence of artificial legs, codes Z97.13, Z91.14, Z97.16

Resources

View the links below to see the official CMS announcement, fact sheet, advance notice of changes and the ICD-10-CM mappings: