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RxHCC If the Disease Group is listed in this column… …Then drop the RxHCC(s) listed in this column

RxHCC Model Hierarchical Condition Category Label

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 NOTES: 1. This table applies to all of the RxHCC models in the CY 2026 Rate Announcement. How Payments are Made with a Disease Hierarchy: EXAMPLE: If a beneficiary triggers RxHCCs 163 (Intractable Epilepsy) and 164 (Epilepsy and Other Seizure Disorders, Except Intractable Epilepsy), then RxHCC 164 will be dropped. In other words, payment will always be associated with the RxHCC in column 1 if an RxHCC in column 3 also occurs during the same collection period. Therefore, the organization’s payment will be based on RxHCC 163 rather than RxHCC 164. SOURCE: RTI International.