CMS Releases the 2026 Midyear/Final HCC Mapping
CMS has published the 2026 Midyear/Final ICD‑10‑CM → HCC V28 mapping for DOS Oct 1, 2025–Sept 30, 2026. If you work in risk adjustment, coding, or clinical documentation, this update is a must‑review.
ProTrust Billing Partners LLC
1/15/20261 min read
Key Highlights from the 2026 Mapping
Updated ICD‑10‑CM code lists aligned to the V28 model
Midyear refinements to ensure clinical accuracy and model integrity
Finalized mappings that organizations must use for risk score calculation and audit readiness
Updated model software and mapping files now available for download on CMS.Gov
Why This Matters
Accurate mapping drives:
Correct HCC assignment
Reliable RAF score calculation
Fewer coding discrepancies and audit vulnerabilities
Better alignment between clinical documentation and risk adjustment outcomes
With V28’s tighter clinical specificity and reduced code set, staying current with mapping updates is essential for both compliance and performance.
Recommended Next Steps for Organizations
Review the 2026 Midyear/Final ICD‑10‑CM Mapping and update internal tools
Refresh provider and coder education to reflect mapping changes
Validate EHR templates, problem lists, and coding workflows
Coordinate with analytics teams to ensure accurate V28 risk score modeling
Reinforce documentation practices that support specificity and MEAT criteria
Bottom Line
The 2026 midyear mapping isn’t just a technical update — it’s a strategic opportunity to strengthen documentation quality, reduce risk, and ensure accurate representation of patient complexity under the V28 model.