2026 ICD-10-CM Diagnosis Code Z95.812Presence of fully implantable artificial heart
ICD-10-CM Codes›Z00–Z99›Z77-Z99›Z95
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 223
- POA Exempt
- Not a Principal Diagnosis
Z95.812 is a billable ICD-10-CM diagnosis code for presence of fully implantable artificial heart. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 314 through 316. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 21 closely related codes. The code is not accepted as a principal diagnosis by the Medicare Code Editor and exempt from POA reporting. Coders also document this condition as dependence on artificial heart. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Heart failure; and Implant, device or graft related encounter.
For Medicare Advantage risk adjustment, Z95.812 maps to CMS-HCC Category 223 (Heart Assist Device/Artificial Heart) under the V28 model, adding a risk factor of about 2.505 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for Z95.812.
Present on Admission (POA)Billing
Z95.812 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).
Medicare Risk Adjustment (HCC)Billing
Z95.812 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Dependence on artificial heart
- Dependence on energy-dependent medical equipment and/or device
- H/O: artificial heart
Index to Diseases and InjuriesGuidance
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Convert Z95.812 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Z95.812Overview
What is the ICD-10 code for presence of fully implantable artificial heart?
The ICD-10-CM code for presence of fully implantable artificial heart is Z95.812 (sometimes written as Z95812). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is Z95.812 (Presence of other cardiac implants and grafts) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report presence of fully implantable artificial heart on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does Z95.812 group to?
On inpatient claims, presence of fully implantable artificial heart maps to MS-DRG 314, 315, 316, with relative weights from 0.6821 to 2.0852 depending on complications. Higher weights mean higher Medicare reimbursement.
Is Z95.812 a CC or MCC?
CMS lists Z95.812 as a CC (complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 21 closely related codes in its exclusion list.
Can Z95.812 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because presence of fully implantable artificial heart describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
What HCC is Z95.812?
Z95.812 (presence of fully implantable artificial heart) maps to CMS-HCC Category 223 (Heart Assist Device/Artificial Heart), commonly written as HCC 223, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 186 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does Z95.812 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, Z95.812 adds a risk adjustment factor of about 2.505 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.826 to 6.612 depending on the payment segment). A more severe related category (HCC 221 and HCC 222) supersedes it when both are reported. See the full factor table on the HCC 223 category page.
