2026 Primary Care Payment Model – Provider Resources and Full Code Sets

Provider Resource Guides

1. 2026 PCPM Provider Resource Guides [PDF]

Stars: Medicare Measures

1. 2026 Stars PCPM Measure Value Set: Breast Cancer Screening [PDF]
2. 2026 Stars PCPM Measure Value Set: Care for Older Adults – Functional Status Assessment [PDF]
3. 2026 Stars PCPM Measure Value Set: Care for Older Adults – Medication Review [PDF]
4. 2026 Stars PCPM Measure Value Set: Colorectal Cancer Screening [PDF]
5. 2026 Stars PCPM Measure Value Set: Concurrent Use of Opioids and Benzodiazepines [PDF]
6. 2026 Stars PCPM Measure Value Set: Controlling High Blood Pressure [PDF]
7. 2026 Stars PCPM Measure Value Set: Eye Exam for Patients With Diabetes [PDF]
8. 2026 Stars PCPM Measure Value Set: Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions [PDF]
9. 2026 Stars PCPM Measure Value Set: Glycemic Status Assessment for Patients With Diabetes (≤9.0%) [PDF]
10. 2026 Stars PCPM Measure Value Set: Kidney Health Evaluation for Patients With Diabetes [PDF]
11. 2026 Stars PCPM Measure Value Set: Medication Adherence for Cholesterol (Statins) [PDF]
12. 2026 Stars PCPM Measure Value Set: Medication Adherence for Diabetes [PDF]
13. 2026 Stars PCPM Measure Value Set: Medication Adherence for Hypertension (RAS Antagonists) [PDF]
14. 2026 Stars PCPM Measure Value Set: Osteoporosis Management in Women Who Had a Fracture [PDF]
15. 2026 Stars PCPM Measure Value Set: Plan All-Cause Readmission [PDF]
16. 2026 Stars PCPM Measure Value Set: Polypharmacy – Use of Multiple Anticholinergic Medications in Older Adults [PDF]
17. 2026 Stars PCPM Measure Value Set: Statin Use in Persons With Diabetes [PDF]
18. 2026 Stars PCPM Measure Value Set: Transitions of Care – Medication Reconciliation [PDF]
19. 2026 Stars PCPM Measure Value Set: Transitions of Care – Patient Engagement After Inpatient Discharge [PDF]

Commercial & QUEST: Commercial & Medicaid Measures

1. 2026 Commercial & Medicaid PCPM Measure Value Set: Child and Adolescent Well-Care Visits [PDF]
2. 2026 Commercial & Medicaid PCPM Measure Value Set: Childhood Immunization Status [PDF]
3. 2026 Commercial & Medicaid PCPM Measure Value Set: Controlling High Blood Pressure [PDF]
4. 2026 Commercial & Medicaid PCPM Measure Value Set: Glycemic Status Assessment for Patients With Diabetes (<8.0%) [PDF]
5. 2026 Commercial & Medicaid PCPM Measure Value Set: Screening for Depression and Follow-Up Plan [PDF]
6. 2026 Commercial & Medicaid PCPM Measure Value Set: Well-Child Visits in the First 30 Months of Life [PDF]

Review of Chronic Conditions: Medicare Measure

1. 2026 Stars PCPM Measure Value Set: Review of Chronic Conditions [PDF]
2. 2026 Acceptable Specialty Types for the Review of Chronic Conditions Measure [PDF]

https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software/icd-10-mappings

Please click on the link to download the full list of Center for Medicare Services (CMS)- Hierarchical Condition Categories (HCC) ICD-10 Codes. After selecting the applicable year, on the next page, click on “(Year selected) Initial ICD-10 Mappings (ZIP)”. Once the file is finished downloading, you will need to open and “unzip” the file to access the excel version of the CMS-HCC ICD-10 Code list. If you experience any issues downloading the file or have any questions regarding the HCC code list, please reach out to PSInquiries@hmsa.com.

2026 PCPM Performance Measures

1. 2026 Medicare, Commercial, and QUEST Measure Cutpoints, Thresholds, and Weights [PDF]

Additional Provider Resources

1. Be Heart Smart Flyer [PDF]
2. Prescription Drugs By Mail Flyer [PDF]

Revision History