RxHCC Hierarchy Explained: Full 2027 Table
RxHCCs are hierarchical: within a disease family, only the most severe manifested category pays. If a member triggers both RXHCC163 (intractable epilepsy) and RXHCC164 (other seizure disorders), RXHCC164 is dropped — payment follows the more severe category. Hierarchies are why "more codes" does not mean "more score": coding a related lower-severity condition adds nothing, while missing the severe one leaves money behind.
The complete CY2027 hierarchy (Table VIII-13)
| If this RxHCC is present… | …these RxHCCs are dropped |
|---|---|
| 15 Chronic Myeloid Leukemia | 17, 18, 19, 20, 21, 22 |
| 16 Multiple Myeloma and Other Hematologic Cancers | 17, 18, 19, 20, 21, 22 |
| 17 Secondary Cancer of Bone and Kidney | 18, 19, 20, 21, 22 |
| 18 Secondary Cancer of Lung, Liver, Brain, and Other Sites | 19, 20, 21, 22 |
| 19 Leukemias and Other Hematologic Cancers | 20, 21, 22 |
| 20 Lung, Kidney, and Other Cancers; Secondary Cancer of Lymph Nodes and Other Sites | 21, 22 |
| 21 Lymphomas and Other Hematologic Cancers | 22 |
| 30 Diabetes with Complications | 31 |
| 40 Alpha-1-Antitrypsin Deficiency | 43 |
| 41 Lysosomal Storage Disorders | 43 |
| 42 Acromegaly and Other Endocrine and Metabolic Disorders | 43 |
| 54 Chronic Viral Hepatitis C | 55 |
| 65 Chronic Pancreatitis | 66 |
| 81 Psoriatic Arthropathy | 83, 84, 316 |
| 82 Systemic Sclerosis | 83, 84 |
| 83 Rheumatoid Arthritis and Other Inflammatory Polyarthropathy | 84 |
| 84 Systemic Lupus Erythematosus and Other Systemic Connective Tissue Disorders | 317 |
| 111 Alzheimer's Disease | 112 |
| 130 Schizophrenia and Other Psychosis | 131, 132, 133 |
| 131 Bipolar Disorders | 132, 133 |
| 132 Depression | 133 |
| 146 Profound or Severe Intellectual Disability/Developmental Disorder | 147, 148 |
| 147 Moderate Intellectual Disability/Developmental Disorder | 148 |
| 157 Chronic Inflammatory Demyelinating Polyneuritis | 158 |
| 163 Intractable Epilepsy | 164 |
| 183 Pulmonary Arterial Hypertension | 184, 186, 187 |
| 184 Pulmonary Hypertension, Except Arterial, and Other Pulmonary Heart Disease | 186, 187 |
| 186 Heart Failure | 187 |
| 225 Cystic Fibrosis | 229 |
| 226 Idiopathic Pulmonary Fibrosis and Systemic Sclerosis with Lung Involvement | 227, 229 |
| 227 Pulmonary Fibrosis, Except Idiopathic | 229 |
| 228 Severe Persistent Asthma | 229 |
| 243 Glaucoma, Open-Angle or Moderate/Severe Stage | 244 |
| 260 Kidney Transplant Status | 261, 262, 263, 396 |
| 261 Dialysis Status, Including End Stage Renal Disease | 262, 263 |
| 262 Chronic Kidney Disease Stage 5 | 263 |
Source: CY2027 Rate Announcement, Table VIII-13. The hierarchy applies across all RxHCC models (MA-PD, PDP, PACE).
Worked example
A member has documented diabetes with complications (RXHCC30, MA-PD community non-LI 65+: 0.429) and diabetes without complication (RXHCC31, 0.232). The hierarchy drops RXHCC31 — the member scores 0.429, not 0.661. If documentation only ever captured "diabetes, uncomplicated" but the record supports complications, the plan is paid 0.232 and leaves 0.197 on the table — the single most common hierarchy leak in Part D.
Frequently asked questions
Do hierarchies differ between MA-PD and PDP in 2027?
No. The coefficients differ by plan type; the hierarchy logic is shared.
Can a member have conditions from multiple families?
Yes — hierarchies only operate within a family. Heart failure, diabetes, and COPD coefficients all stack.
Where do hierarchies bite hardest operationally?
Diabetes (30/31), psychiatric disorders (130–133), and pulmonary disease (225–229) — high-prevalence families where documentation specificity determines which rung pays.