The V28 CMS-HCC model is fully phased in for 2026 payment, and the changes are easiest to understand condition by condition rather than as a list of numbers.
What changed overall
- The model was recalibrated on newer data and restructured, with many HCCs renumbered.
- CMS removed a large number of diagnosis codes from payment, including many with high discretion or variable coding.
- Some related HCCs were constrained to equal coefficients.
- The transition ran in thirds: blended V24/V28 in 2024 and 2025, then 100% V28 for 2026.
Always confirm specifics in the CMS Rate Announcement and model software; the table below is a coder’s orientation, not a payment schedule.
Condition quick-reference
| Condition area | What changed in V28 | Coder focus |
|---|---|---|
| Diabetes | Three diabetes HCCs share one coefficient | Document type and complications anyway; see diabetes V24 vs V28 |
| Heart failure | Single V24 category split into graded heart failure HCCs | Capture type and acuity; see heart failure mapping |
| Angina | Removed from payment | Do not expect HCC value; still code accurately |
| Depression | Milder major depressive disorder severities no longer risk-adjust | Document severity and remission status |
| Malnutrition | Narrowed to more severe presentations | Support with clinical criteria |
| Vascular disease | Several unspecified atherosclerosis codes dropped | Specify site and complication |
What did not change
Documentation rules. A diagnosis must still be supported by a face-to-face encounter, evaluated or treated, and documented by an acceptable provider. Removal of a code from payment never makes it optional to code.
Using Lynceus to check
- Search the code in Lynceus and open its page, for example E11.22.
- Open the HCC Crosswalk to compare V24 and V28.
- Test a patient profile in the RAF Calculator.
For deeper reading, see CMS-HCC V24 vs V28: Key Differences.
Takeaway
V28 shifts value away from vague or discretionary diagnoses and toward clinically specific ones. Code what is documented, query for specificity, and verify mapping before you assume a diagnosis carries weight.