CMS-HCC V28 RAF Calculator + Problem List Parser

2026 Medicare Advantage model · Parses Epic-style problem lists · Official final CMS mappings and coefficients

◉ Offline & local — entered data never leaves this file
Raw model estimate: This calculates the CMS-HCC V28 model score using the selected segment. It does not apply normalization, the MA coding-pattern adjustment, plan-specific blending, frailty, ESRD, or payment calculations. Clinician and analytic use only.

Patient & model inputs

Epic SmartPhrase template 
DOB: @DOB@
AGE: @AGE@
SEX: @LEGALSEX@
Problems: 
@PROB@
Demographics

The parser recognizes common Epic formatting and extracts DOB or age, sex, problem-list terms, and any ICD-10-CM codes that are present.

Problem-list text is not coding documentation. Only exact or specifically curated matches are counted automatically; ambiguous terms are displayed for review and do not increase the score.
Enrollment segment

For patients under 65, community coefficients automatically use the disabled segment.

Advanced: add confirmed ICD-10-CM codes

These codes bypass free-text matching. Codes may be separated by spaces, commas, or lines; duplicates are removed.

Paste demographics and an Epic problem list
The result will show the parsed problems, confirmed mappings, active HCCs, hierarchy suppression, and every coefficient used.
Raw model score
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Demographic
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age, sex, status
HCCs
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Interactions
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including HCC count

Age is calculated as of February 1, 2026, matching the CMS reference software, or accepted directly when only age is supplied. Problem-list labels are matched locally to official ICD-10-CM descriptions using exact normalized terms and a small conservative clinical alias set. Ambiguous suggestions are never counted automatically. Confirmed codes are mapped to condition categories, required age/sex edits are applied, HCC hierarchies suppress lower categories, V28 disease and disabled interactions are created, and the selected model coefficients are summed.

What this score excludes
Normalization, the statutory MA coding-pattern adjustment, frailty, ESRD models, RxHCC, encounter eligibility rules, data-submission acceptance, and plan/payment calculations are outside this tool. New enrollee scores are demographic-only under the CMS model.
Source files embedded in this calculator
CMS 2026 Midyear/Final Model Software (Python) and 2026 Midyear/Final ICD-10-CM mappings, retrieved from the CMS Risk Adjustment model software page. Model package: CMS_HCC_v28_2026_T_package_v3.