2027 RxHCC Coefficients: Full MA-PD and PDP Table
CMS finalized the CY2027 RxHCC model on April 6, 2026 in the CY2027 Rate Announcement. For the first time, the model uses separate segments for MA-PD and standalone PDP populations, so the same diagnosis now pays differently depending on plan type. The model is calibrated on 2023 diagnoses and 2024 expenditure data, and reflects the Inflation Reduction Act's CY2027 Part D benefit design, including adjustments for drugs with maximum fair prices (MFPs) from the Medicare Drug Price Negotiation Program.
The table below shows the continuing enrollee, community, non-low-income, age 65+ segment — the largest enrollment cell for most plans. The full model has five segments per plan type (community non-LI 65+, community non-LI under 65, community LI 65+, community LI under 65, institutional). Download the complete CSV with all segments.
CY2027 RxHCC relative factors (continuing enrollees, community non-LI age 65+)
| RxHCC | Condition category | 2027 MA-PD | 2027 PDP | 2026 (all plans) | Δ 2026→2027 |
|---|---|---|---|---|---|
| RXHCC1 | HIV/AIDS | 8.304 | 9.794 | 8.325 | -0.3% |
| RXHCC5 | Opportunistic Infections | 0.603 | 0.612 | 0.654 | -7.8% |
| RXHCC15 | Chronic Myeloid Leukemia | 5.500 | 6.057 | 4.907 | +12.1% |
| RXHCC16 | Multiple Myeloma and Other Hematologic Cancers | 13.265 | 14.286 | 11.150 | +19.0% |
| RXHCC17 | Secondary Cancer of Bone and Kidney | 5.500 | 6.057 | 4.907 | +12.1% |
| RXHCC18 | Secondary Cancer of Lung, Liver, Brain, and Other Sites | 2.953 | 3.401 | 2.456 | +20.2% |
| RXHCC19 | Leukemias and Other Hematologic Cancers | 2.953 | 3.401 | 2.456 | +20.2% |
| RXHCC20 | Lung, Kidney, and Other Cancers; Secondary Cancer of Lymph Nodes and Other Sites | 0.678 | 0.832 | 0.595 | +13.9% |
| RXHCC21 | Lymphomas and Other Hematologic Cancers | 0.678 | 0.832 | 0.595 | +13.9% |
| RXHCC22 | Prostate, Breast, Bladder, and Other Cancers and Tumors | 0.152 | 0.150 | 0.123 | +23.6% |
| RXHCC30 | Diabetes with Complications | 0.429 | 0.616 | 0.567 | -24.3% |
| RXHCC31 | Diabetes without Complication | 0.232 | 0.299 | 0.248 | -6.5% |
| RXHCC40 | Alpha-1-Antitrypsin Deficiency | 2.285 | 2.285 | 2.571 | -11.1% |
| RXHCC41 | Lysosomal Storage Disorders | 4.133 | 8.193 | 4.668 | -11.5% |
| RXHCC42 | Acromegaly and Other Endocrine and Metabolic Disorders | 2.505 | 3.420 | 2.401 | +4.3% |
| RXHCC43 | Pituitary, Adrenal Gland, and Other Endocrine and Metabolic Disorders | 0.023 | 0.072 | 0.038 | -39.5% |
| RXHCC44 | Thyroid Disorders | 0.054 | 0.052 | 0.068 | -20.6% |
| RXHCC47 | Disorders of Lipoid Metabolism | — | — | — | |
| RXHCC54 | Chronic Viral Hepatitis C | 0.211 | 0.104 | 0.253 | -16.6% |
| RXHCC55 | Acute or Unspecified Viral Hepatitis C | 0.211 | 0.104 | 0.253 | -16.6% |
| RXHCC56 | Chronic Viral Hepatitis B and Other Specified Chronic Viral Hepatitis | 0.140 | 0.533 | 0.264 | -47.0% |
| RXHCC59 | Primary Biliary Cirrhosis | 1.035 | 1.089 | 1.003 | +3.2% |
| RXHCC65 | Chronic Pancreatitis | 0.202 | 0.423 | 0.375 | -46.1% |
| RXHCC66 | Pancreatic Disorders and Intestinal Malabsorption, Except Pancreatitis | 0.202 | 0.299 | 0.279 | -27.6% |
| RXHCC67 | Inflammatory Bowel Disease | 0.362 | 0.551 | 0.425 | -14.8% |
| RXHCC80 | Aseptic Necrosis of Bone | 0.103 | 0.230 | 0.170 | -39.4% |
| RXHCC81 | Psoriatic Arthropathy | 0.719 | 0.933 | 0.755 | -4.8% |
| RXHCC82 | Systemic Sclerosis | 1.429 | 1.691 | 1.282 | +11.5% |
| RXHCC83 | Rheumatoid Arthritis and Other Inflammatory Polyarthropathy | 0.139 | 0.172 | 0.161 | -13.7% |
| RXHCC84 | Systemic Lupus Erythematosus and Other Systemic Connective Tissue Disorders | 0.114 | 0.146 | 0.136 | -16.2% |
| RXHCC87 | Osteoporosis, Vertebral and Pathological Fractures | 0.050 | 0.060 | 0.044 | +13.6% |
| RXHCC95 | Sickle Cell Anemia | 0.014 | — | — | |
| RXHCC96 | Acquired Hemolytic, Aplastic, and Sideroblastic Anemias | 1.076 | 1.038 | 0.880 | +22.3% |
| RXHCC98 | Hereditary Angioedema and Other Defects in the Complement System | 6.992 | 11.918 | 9.161 | -23.7% |
| RXHCC99 | Immune Disorders | 0.418 | 0.948 | 0.449 | -6.9% |
| RXHCC100 | Immune Thrombocytopenic Purpura | 0.449 | 0.700 | 0.478 | -6.1% |
| RXHCC111 | Alzheimer's Disease | — | — | — | |
| RXHCC112 | Dementia, Except Alzheimer's Disease | — | — | — | |
| RXHCC130 | Schizophrenia and Other Psychosis | 0.249 | 0.362 | 0.261 | -4.6% |
| RXHCC131 | Bipolar Disorders | 0.225 | 0.324 | 0.254 | -11.4% |
| RXHCC132 | Depression | 0.040 | 0.039 | 0.040 | +0.0% |
| RXHCC133 | Anxiety and Other Psychiatric Disorders | 0.023 | 0.009 | 0.032 | -28.1% |
| RXHCC146 | Profound or Severe Intellectual Disability/Developmental Disorder | 0.811 | 1.009 | 0.525 | +54.5% |
| RXHCC147 | Moderate Intellectual Disability/Developmental Disorder | 0.811 | 1.009 | 0.525 | +54.5% |
| RXHCC148 | Mild or Unspecified Intellectual Disability/Developmental Disorder | 0.811 | 1.009 | 0.525 | +54.5% |
| RXHCC153 | Myasthenia Gravis and Other Myoneural Disorders | 2.067 | 2.558 | 1.972 | +4.8% |
| RXHCC154 | Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease | 3.827 | 4.954 | 4.754 | -19.5% |
| RXHCC155 | Spinal Cord Disorders | 0.054 | 0.099 | 0.057 | -5.3% |
| RXHCC157 | Chronic Inflammatory Demyelinating Polyneuritis | 4.803 | 5.388 | 4.666 | +2.9% |
| RXHCC158 | Inflammatory and Toxic Neuropathy | — | 0.085 | — | |
| RXHCC159 | Multiple Sclerosis | 0.681 | 1.087 | 1.113 | -38.8% |
| RXHCC160 | Huntington Disease | 1.957 | 2.477 | 1.896 | +3.2% |
| RXHCC161 | Parkinson Disease | 0.320 | 0.498 | 0.480 | -33.3% |
| RXHCC163 | Intractable Epilepsy | — | 0.107 | 0.120 | |
| RXHCC164 | Epilepsy and Other Seizure Disorders, Except Intractable Epilepsy | — | — | — | |
| RXHCC166 | Migraine Headaches | 0.107 | 0.139 | 0.118 | -9.3% |
| RXHCC168 | Trigeminal and Postherpetic Neuralgia | 0.039 | 0.045 | 0.063 | -38.1% |
| RXHCC183 | Pulmonary Arterial Hypertension | 1.901 | 3.492 | 1.832 | +3.8% |
| RXHCC184 | Pulmonary Hypertension, Except Arterial, and Other Pulmonary Heart Disease | 0.232 | 0.357 | 0.177 | +31.1% |
| RXHCC186 | Heart Failure | 0.163 | 0.260 | 0.135 | +20.7% |
| RXHCC187 | Hypertension | 0.045 | 0.032 | 0.046 | -2.2% |
| RXHCC188 | Coronary Artery Disease | 0.066 | 0.036 | 0.061 | +8.2% |
| RXHCC191 | Ventricular Septal Defect and Major Congenital Heart Disorders | 0.138 | 0.335 | 0.185 | -25.4% |
| RXHCC193 | Atrial Arrhythmias | 0.231 | 0.238 | 0.214 | +7.9% |
| RXHCC207 | Spastic Hemiplegia | — | — | — | |
| RXHCC215 | Venous Thromboembolism | 0.257 | 0.239 | 0.219 | +17.4% |
| RXHCC225 | Cystic Fibrosis | 8.032 | 19.750 | 10.360 | -22.5% |
| RXHCC226 | Idiopathic Pulmonary Fibrosis and Systemic Sclerosis with Lung Involvement | 2.752 | 3.873 | 3.683 | -25.3% |
| RXHCC227 | Pulmonary Fibrosis, Except Idiopathic | 0.273 | 0.576 | 0.335 | -18.5% |
| RXHCC228 | Severe Persistent Asthma | 0.904 | 0.795 | 0.978 | -7.6% |
| RXHCC229 | Chronic Obstructive Pulmonary Disease, Bronchiectasis, and Other Asthma | 0.170 | 0.192 | 0.214 | -20.6% |
| RXHCC243 | Glaucoma, Open-Angle or Moderate/Severe Stage | 0.095 | 0.124 | 0.136 | -30.1% |
| RXHCC244 | Other Non-Acute Glaucoma | 0.022 | 0.019 | — | |
| RXHCC260 | Kidney Transplant Status | — | — | — | |
| RXHCC261 | Dialysis Status, Including End Stage Renal Disease | — | — | 0.009 | |
| RXHCC262 | Chronic Kidney Disease Stage 5 | — | — | 0.009 | |
| RXHCC263 | Chronic Kidney Disease Stage 4 | — | — | 0.009 | |
| RXHCC311 | Chronic Ulcer of Skin, Except Pressure | 0.071 | 0.047 | 0.135 | -47.4% |
| RXHCC314 | Pemphigus, Pemphigoid, and Other Bullous Skin Disorders | 0.295 | 0.348 | 0.280 | +5.4% |
| RXHCC316 | Psoriasis, Except with Arthropathy | 0.198 | 0.286 | 0.198 | +0.0% |
| RXHCC317 | Discoid Lupus Erythematosus | 0.064 | 0.146 | 0.076 | -15.8% |
| RXHCC355 | Narcolepsy and Cataplexy | 0.888 | 1.515 | 0.922 | -3.7% |
| RXHCC395 | Stem Cell, Including Bone Marrow, Transplant Status/Complications | 3.930 | 4.047 | 3.425 | +14.7% |
| RXHCC396 | Heart, Lung, Liver, Intestine, or Pancreas Transplant Status | — | — | — |
Source: CY2027 Rate Announcement, Table VIII-1 (MA-PD) and Table VIII-5 (PDP), 2023/2024 calibration. 2026 values from the CY2026 Rate Announcement, Table VIII-1. Dashes indicate cells with no published coefficient (too few beneficiaries to estimate).
How to read these numbers
A coefficient is the marginal contribution of that condition to a member's Part D risk score, before the normalization factor. A member's raw score is the sum of demographic factors plus all applicable disease coefficients, after hierarchies are applied (a more severe condition in the same family zeroes out the less severe one — see the hierarchy table). The plan payment then divides by the normalization factor — 1.109 for MA-PD plans and 1.005 for PDPs in 2027 — so a raw MA-PD score of 1.109 pays as 1.0.
What changed that matters most
- MA-PD vs PDP divergence. The same condition now carries different weights by plan type. RXHCC186 (Heart Failure), RXHCC30 (Diabetes with Complications), and the hepatitis C categories show meaningful MA-PD/PDP gaps. Plans that modeled 2027 bids on a single coefficient set mis-priced.
- Oncology coefficients rose sharply. Multiple myeloma (RXHCC16) is up ~19% and chronic myeloid leukemia (RXHCC15) ~12% in the headline segment, reflecting post-IRA catastrophic-phase economics where plans bear 60% of costs.
- Audio-only and unlinked chart review diagnoses are excluded. Diagnoses from audio-only visits and unlinked chart review records no longer count for 2027 payment, which changes both documentation strategy and RADV exposure.
- Several status categories dropped from the continuing-enrollee tables. Kidney transplant status (RXHCC260), dialysis status (RXHCC261), CKD stages 4–5 (RXHCC262–263), Alzheimer's (RXHCC111) and dementia (RXHCC112) show no published continuing-enrollee disease coefficients for 2027 — the kidney categories carried small community coefficients in 2026. Verify treatment for your population against the new-enrollee tables and the 2027 model software.
Frequently asked questions
Where do I get the official coefficients?
CMS publishes them in the CY2027 Rate Announcement, Tables VIII-1 through VIII-12, and as machine-readable files in the 2027 model software on CMS.gov. Our CSV above reproduces Tables VIII-1 and VIII-5 for continuing enrollees.
Do MA-PD and PDP coefficients really differ now?
Yes. CY2027 is the first year the disease coefficients themselves are segmented by plan type, not just the normalization factors. CMS finalized this to improve predictive accuracy for both populations.
How do coefficients become dollars?
Risk score x the Part D national average monthly bid amount drives the direct subsidy. A 0.10 change in a member's score is worth roughly $57 PMPY per 0.01 of bid — the exact math is in our direct subsidy calculation guide.
*CuraFi helps MA-PD plans, PDPs, and ACOs operationalize the 2027 model — provider-aligned documentation, compliant coding workflows, and population-level impact analysis. Talk to us.*