RAF Score Cheat Sheet (2026): The RAF Score List, Ranges and Improvement Guide
Bookmark this as your quick reference for the CMS RAF score calculation, RAF score ranges, and accurate ways to improve RAF scores. For the full explanation behind each item, see what a RAF score is and how HCC coding builds it.
On this page
Cheat sheet — the essentials
- RAF = Demographics + HCCs + Interactions, normalized so 1.0 = average beneficiary.
- Conditions must be re-documented and re-coded every calendar year to keep counting.
- Model in force: PY2026 = 100% CMS-HCC V28 (V24 fully retired for payment).
Source: CMS CY2024 Medicare Advantage and Part D Rate Announcement.
The RAF Score Formula (CMS RAF Score Calculation)
Every CMS RAF score calculation follows the same structure regardless of model version:
RAF = Demographic coefficients + HCC disease coefficients + Interaction terms → × normalization factor × coding-pattern adjustment
Each documented ICD-10 code is mapped via the ICD-10 to HCC crosswalk to an HCC; each HCC and demographic attribute carries a coefficient; the coefficients are summed and normalized. Because the mapping changes by model version, most teams use the RAF Score Calculator instead of computing by hand.
RAF Score List: Components and Factors
This is the core RAF score list — every input that can move a member's score:
| Factor group | What it includes | Notes |
|---|---|---|
| Demographic | Age/sex band, original reason for entitlement (disability), Medicaid/dual status | Always applies; new enrollees use a demographic-only model |
| Residence status | Community vs. institutional; dual vs. non-dual community segments | Separate coefficient sets per segment |
| HCC disease factors | Chronic conditions grouped into HCCs from ICD-10 codes | Hierarchical — only the most severe HCC in a family counts |
| Interaction terms | High-cost condition combinations (e.g., diabetes + CKD, CHF + COPD) | Add-on weight beyond the individual HCCs |
| Normalization factor | CMS annual factor keeping scores comparable year over year | Published in each year's Rate Announcement |
| Coding-pattern adjustment | MA coding-intensity reduction applied by CMS | Reduces aggregate MA scores by a set percentage |
For how diagnosis codes turn into HCC factors, see HCC and RAF explained; for the V28 specifics, see Understanding HCC V28.
RAF Score Ranges
RAF has no fixed maximum, but typical reference points (illustrative; vary by model/year/population):
| RAF score range | Typical member profile |
|---|---|
| Below ~0.7 | Younger or healthy member, few/no documented chronic conditions |
| ~0.9 – 1.1 | Average risk (1.0 = CMS normalization baseline) |
| ~1.2 – 2.0 | Multiple managed chronic conditions |
| Above ~2.0 | High-acuity / complex, often with interactions or institutional status |
How to Improve RAF Scores (the Accurate Way)
"Improving RAF scores" and getting an "increase in RAF scores" should always mean closing the gap between documented and true acuity — never coding unsupported conditions. The compliant levers:
| Lever | Why it raises an accurate RAF |
|---|---|
| Annual re-documentation of every chronic condition | HCCs reset yearly; an uncoded condition contributes 0 this year |
| Code to highest supported specificity | Vague codes may not risk-adjust; specific codes map to weighted HCCs |
| Capture condition interactions | Interaction terms add weight that single-condition coding misses |
| Documentation meets MEAT criteria | Monitored/Evaluated/Assessed/Treated evidence makes the HCC defensible at RADV audit |
| Close suspected-condition gaps before year end | Recaptures conditions that lapsed since the prior year |
The wrong way — coding diagnoses the record does not support — inflates RAF temporarily and creates RADV-audit and False Claims Act exposure. Accuracy, not maximization, is the goal. See why MA RAF accuracy matters.
2021 / 2022 RAF Cheat Sheets vs. 2026: What Changed
If you are working from a raf score cheat sheet 2021, raf score cheat sheet 2022, or other "raf scores 2021" reference, the formula still holds — but the numbers do not. Those were built on CMS-HCC V24. Since then CMS phased in V28:
| Payment year | Model blend | Cheat-sheet impact |
|---|---|---|
| 2021 / 2022 | 100% V24 | Old HCC numbers and coefficients; ~86 payment HCCs |
| PY2024 | 67% V24 / 33% V28 | Blended — neither old nor new cheat sheet is exact |
| PY2025 | 33% V24 / 67% V28 | V28-weighted |
| PY2026 | 100% V28 | Use V28: ~115 HCCs, renumbered, many codes removed |
Bottom line: keep the structure from a 2021/2022 cheat sheet, but pull current coefficients from the RAF Score Calculator and compare versions with the RAF V24 vs V28 tool.
Use or cite this RAF score cheat sheet
This reference is free to use and link to. If it helps your team or readers, a citation back to this page (rafscorecalculator.com/raf-score-cheat-sheet) is appreciated — coding programs, training decks, and healthcare blogs are welcome to reference the component list and ranges with attribution.
Maintained by VBC Risk Analytics; updated each payment year against the current CMS Rate Announcement.
Skip the lookup — calculate it
Paste ICD-10 codes; the calculator applies the current-year coefficients and returns the RAF score instantly.
Open the RAF Score CalculatorFrequently Asked Questions
The RAF formula, demographic factors, HCC disease factors, interaction terms, normalization and coding-pattern adjustments, typical RAF score ranges, and the documentation rules that make each factor count.
The formula structure is unchanged, but 2021/2022 cheat sheets are V24-based. CMS is now at 100% V28 (PY2026), so HCC numbering, included codes, and coefficients differ — use current-year values.
RAF = demographic coefficients + HCC disease coefficients (from ICD-10 codes) + interaction terms, then adjusted by a normalization factor and coding-pattern adjustment, with 1.0 as the average beneficiary.
Re-document all chronic conditions annually, code to the highest supported specificity, capture interactions, and ensure documentation meets MEAT criteria — never code unsupported diagnoses.
Most community Medicare members fall roughly between 0.7 and 2.0, with 1.0 as the average baseline and high-acuity members above 2.0. There is no fixed maximum.
Common RAF mistakes (the inverse of this cheat sheet)
- Skipping annual recapture — last year's HCCs do not carry over automatically.
- Coding to the unspecified default instead of the documented specificity.
- Chasing a higher number rather than a defensible one (RADV / False Claims risk).
- Using a 2021/2022 (V24) reference for a PY2026 (V28) calculation.
General compliance guidance; confirm specifics against the current CMS Rate Announcement and your organization's policy.
This page is educational and does not constitute coding, billing, legal, or clinical advice. RAF coefficients and CMS-HCC model rules change by payment year; always confirm against the current CMS Rate Announcement and your organization's compliance guidance. CPT® is a registered trademark of the American Medical Association; HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). This page is independent and is not affiliated with, endorsed by, or sponsored by CMS, the AMA, or NCQA.