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Hierarchal Condition Categories (HCCs)

What are hierarchal condition categories (HCCs)?

Hierarchal condition categories (HCCs) are medical codes that correspond to certain clinical diagnoses. The Centers for Medicare and Medicaid Services (CMS) utilizes HCCs to identify patients with chronic or severe acute conditions for the risk adjustment model.  

HCCs code for diagnoses with similar expected annual care costs and clinical complexity. Codes are organized under smaller categories.  

Some common HCCs include: 

  • Diabetes 
  • Congestive heart failure 
  • Depression  

Why are hierarchal condition categories (HCCs) important to healthcare?

Hierarchal condition categories are important to healthcare because they determine the future annual cost of care and expected risk. Generally, clinicians treating patients with higher-risk conditions will have higher reimbursement rates. HCCs also determine the amount of money that healthcare organizations receive from CMS.