Is this HCC RAF score calculator free?

Yes, completely free. No account, login, or credit card required.

Which CMS-HCC model version does this calculator use?

It uses CMS-HCC V28, the current model used for Medicare Advantage risk adjustment beginning in payment year 2024.

RAF stands for Risk Adjustment Factor. It is a score reflecting a patient's expected healthcare costs relative to the average Medicare beneficiary. A score of 1.0 is average. Higher scores indicate higher expected costs and result in higher capitated payments to Medicare Advantage plans.

What inputs does the HCC calculator require?

Patient demographics (age, sex, Medicaid dual-eligible status, disability status) and one or more ICD-10-CM diagnosis codes.

Can I use this for official CMS submissions?

No. This tool is for estimation and educational purposes only. Official RAF calculations for CMS submissions must use CMS-certified grouper software.

HCC RAF Score Calculator

Medicare Advantage risk adjustment · CMS-HCC Model V28

2 of 2 calculations left

Patient Demographics

Age

Gender

Status

ICD-10 Diagnoses

No diagnoses added

Search above to add ICD-10 codes

Base Payment Rate

Monthly per-member per-month (PMPM) base rate. County-specific — typical range $700–$1,400. Contact your Medicare Administrative Contractor (MAC) for exact values.

$/ month PMPM

RAF Score · CMS-HCC V28

0.379

Low risk

Payment Impact

Per member · per month (PMPM)

Base Rate$900

Risk-Adjusted Rate$341

Monthly Difference-$559

Annual projection-$6,707/yr

Score Breakdown

Demographics

72y · Female · Community

0.379

Total RAF Score0.379

Pro Features

• Unlimited calculations
• Save & compare scenarios
• Export to PDF & Excel
• Historical tracking

Disclaimer: This calculator is for educational and estimation purposes only. Results are based on CMS-HCC Model V28 with a representative subset of ICD-10 codes. Actual RAF scores as determined by CMS may differ. Not intended for use in official plan submissions or regulatory filings. Consult CMS documentation and a qualified actuary for official calculations.

Related Guides

HCC Risk Adjustment

RAF scores, CMS-HCC V28 models, and Medicare Advantage coding.

HEDIS Measures

Quality measure specifications, numerator/denominator logic, and NCQA reporting.

ICD-10 Guide

ICD-10-CM codes, structure, and database integration.