HCC

A Hierarchical Condition Category (HCC) is a risk-adjustment model used by CMS for Medicare Advantage and some Medicaid managed care plans. HCC codes group ICD-10 diagnoses into clinically meaningful risk categories; the higher the HCC score, the higher the plan's capitation payment from CMS. For behavioral health billing, accurately documenting psychiatric diagnoses with their full HCC-mapped ICD-10 specificity is important for risk adjustment accuracy, though HCC is not directly implicated in typical denial appeals.