To ensure proper payments for Medicare Advantage beneficiaries, CMS uses a risk adjustment model based on hierarchical condition categories, according to Anesthesia Business Consultants President and CEO Tony Mira.
Four new hierarchical chronic condition codes were added in 2019. Know these codes to ensure proper payment:
1. HCC 56: Drug abuse, uncomplicated, except cannabis
2. HCC 58: Reactive and unspecified psychosis
3. HCC 60: Personality disorders
4. HCC 138: Chronic kidney disease, moderate (stage 3)