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RxHCC Condition Categories: Complete 2027 List
The CY2027 RxHCC model contains 84 payment categories. This is the full list as published in the CY2027 Rate Announcement continuing-enrollee tables (Tables VIII-1 and VIII-5). For the payment weights attached to each category, see the 2027 coefficients table; for which categories override which, see the hierarchy table.
| RxHCC | Condition category |
|---|---|
| RXHCC1 | HIV/AIDS |
| RXHCC5 | Opportunistic Infections |
| RXHCC15 | Chronic Myeloid Leukemia |
| RXHCC16 | Multiple Myeloma and Other Hematologic Cancers |
| RXHCC17 | Secondary Cancer of Bone and Kidney |
| RXHCC18 | Secondary Cancer of Lung, Liver, Brain, and Other Sites |
| RXHCC19 | Leukemias and Other Hematologic Cancers |
| RXHCC20 | Lung, Kidney, and Other Cancers; Secondary Cancer of Lymph Nodes and Other Sites |
| RXHCC21 | Lymphomas and Other Hematologic Cancers |
| RXHCC22 | Prostate, Breast, Bladder, and Other Cancers and Tumors |
| RXHCC30 | Diabetes with Complications |
| RXHCC31 | Diabetes without Complication |
| RXHCC40 | Alpha-1-Antitrypsin Deficiency |
| RXHCC41 | Lysosomal Storage Disorders |
| RXHCC42 | Acromegaly and Other Endocrine and Metabolic Disorders |
| RXHCC43 | Pituitary, Adrenal Gland, and Other Endocrine and Metabolic Disorders |
| RXHCC44 | Thyroid Disorders |
| RXHCC47 | Disorders of Lipoid Metabolism |
| RXHCC54 | Chronic Viral Hepatitis C |
| RXHCC55 | Acute or Unspecified Viral Hepatitis C |
| RXHCC56 | Chronic Viral Hepatitis B and Other Specified Chronic Viral Hepatitis |
| RXHCC59 | Primary Biliary Cirrhosis |
| RXHCC65 | Chronic Pancreatitis |
| RXHCC66 | Pancreatic Disorders and Intestinal Malabsorption, Except Pancreatitis |
| RXHCC67 | Inflammatory Bowel Disease |
| RXHCC80 | Aseptic Necrosis of Bone |
| RXHCC81 | Psoriatic Arthropathy |
| RXHCC82 | Systemic Sclerosis |
| RXHCC83 | Rheumatoid Arthritis and Other Inflammatory Polyarthropathy |
| RXHCC84 | Systemic Lupus Erythematosus and Other Systemic Connective Tissue Disorders |
| RXHCC87 | Osteoporosis, Vertebral and Pathological Fractures |
| RXHCC95 | Sickle Cell Anemia |
| RXHCC96 | Acquired Hemolytic, Aplastic, and Sideroblastic Anemias |
| RXHCC98 | Hereditary Angioedema and Other Defects in the Complement System |
| RXHCC99 | Immune Disorders |
| RXHCC100 | Immune Thrombocytopenic Purpura |
| RXHCC111 | Alzheimer's Disease |
| RXHCC112 | Dementia, Except Alzheimer's Disease |
| RXHCC130 | Schizophrenia and Other Psychosis |
| RXHCC131 | Bipolar Disorders |
| RXHCC132 | Depression |
| RXHCC133 | Anxiety and Other Psychiatric Disorders |
| RXHCC146 | Profound or Severe Intellectual Disability/Developmental Disorder |
| RXHCC147 | Moderate Intellectual Disability/Developmental Disorder |
| RXHCC148 | Mild or Unspecified Intellectual Disability/Developmental Disorder |
| RXHCC153 | Myasthenia Gravis and Other Myoneural Disorders |
| RXHCC154 | Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease |
| RXHCC155 | Spinal Cord Disorders |
| RXHCC157 | Chronic Inflammatory Demyelinating Polyneuritis |
| RXHCC158 | Inflammatory and Toxic Neuropathy |
| RXHCC159 | Multiple Sclerosis |
| RXHCC160 | Huntington Disease |
| RXHCC161 | Parkinson Disease |
| RXHCC163 | Intractable Epilepsy |
| RXHCC164 | Epilepsy and Other Seizure Disorders, Except Intractable Epilepsy |
| RXHCC166 | Migraine Headaches |
| RXHCC168 | Trigeminal and Postherpetic Neuralgia |
| RXHCC183 | Pulmonary Arterial Hypertension |
| RXHCC184 | Pulmonary Hypertension, Except Arterial, and Other Pulmonary Heart Disease |
| RXHCC186 | Heart Failure |
| RXHCC187 | Hypertension |
| RXHCC188 | Coronary Artery Disease |
| RXHCC191 | Ventricular Septal Defect and Major Congenital Heart Disorders |
| RXHCC193 | Atrial Arrhythmias |
| RXHCC207 | Spastic Hemiplegia |
| RXHCC215 | Venous Thromboembolism |
| RXHCC225 | Cystic Fibrosis |
| RXHCC226 | Idiopathic Pulmonary Fibrosis and Systemic Sclerosis with Lung Involvement |
| RXHCC227 | Pulmonary Fibrosis, Except Idiopathic |
| RXHCC228 | Severe Persistent Asthma |
| RXHCC229 | Chronic Obstructive Pulmonary Disease, Bronchiectasis, and Other Asthma |
| RXHCC243 | Glaucoma, Open-Angle or Moderate/Severe Stage |
| RXHCC244 | Other Non-Acute Glaucoma |
| RXHCC260 | Kidney Transplant Status |
| RXHCC261 | Dialysis Status, Including End Stage Renal Disease |
| RXHCC262 | Chronic Kidney Disease Stage 5 |
| RXHCC263 | Chronic Kidney Disease Stage 4 |
| RXHCC311 | Chronic Ulcer of Skin, Except Pressure |
| RXHCC314 | Pemphigus, Pemphigoid, and Other Bullous Skin Disorders |
| RXHCC316 | Psoriasis, Except with Arthropathy |
| RXHCC317 | Discoid Lupus Erythematosus |
| RXHCC355 | Narcolepsy and Cataplexy |
| RXHCC395 | Stem Cell, Including Bone Marrow, Transplant Status/Complications |
| RXHCC396 | Heart, Lung, Liver, Intestine, or Pancreas Transplant Status |
Notes
- Categories marked with "—" coefficients in the coefficients table (for example RXHCC111 Alzheimer's Disease and the transplant/dialysis status categories) remain in the model structure but carry no published continuing-enrollee disease coefficient for 2027.
- The same category can pay differently in MA-PD vs PDP segments in 2027 — see MA-PD vs PDP segments.
- ICD-10 codes map into these categories via CMS's published mappings — see ICD-10 to RxHCC mapping.
*CuraFi helps plans find which of these 84 categories are documented but uncoded in their populations. Talk to us.*