Chronic hepatitis B related hepatocellular carcinoma (HCC) is a leading cause of cancer death in hepatitis B virus endemic areas including the Asia-Pacific region. The risk of HCC development can be reduced by antiviral therapy and surveillance programs. However, this would place a heavy fiscal burden on low- and middle-income countries, which are in these endemic areas. Therefore, there is a need for accurate prediction of HCC risk to prioritize patient care. Based on well-established host and viral risk factors, several HCC risk scores have been derived and validated: GAG-HCC, CU-HCC, and REACH-B for Asians and PAGE-B for white people of European ancestry. Each score has been shown to be accurate in predicting HCC up to 10 years into the future when applied to the appropriate patient group, especially with regards to their ethnicity and antiviral therapy status. Recently noninvasive tests of liver fibrosis have been integrated into existing HCC risk scores with encouraging results. As HCC risk prediction continues to evolve, the future promises a more individualized approach to HCC surveillance, ultimately leading to improved patient care and resource allocation.