HCC 211: Respirator Dependence/Tracheostomy Status/Complications ICD-10-CM
CMS-HCC Category 211 (Respirator Dependence/Tracheostomy Status/Complications) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.590 and 1.981 to a beneficiary's RAF score depending on the payment segment (0.879 for a community, non-dual, aged enrollee). 13 ICD-10-CM diagnosis codes map to HCC 211. It sits at the top of its hierarchy: no other condition category supersedes it.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.879 |
| Community, partial-benefit dual, aged | 1.022 |
| Community, full-benefit dual, aged | 1.981 |
| Community, non-dual, disabled | 0.878 |
| Community, partial-benefit dual, disabled | 0.590 |
| Community, full-benefit dual, disabled | 1.418 |
| Institutional | 1.570 |
A beneficiary is scored in exactly one segment, set by Medicaid (dual) status, aged or disabled entitlement, and residence. Factors are relative weights, not dollar amounts; new-enrollee segments score on demographics only. HCC 211 in turn supersedes HCC 212 (Respiratory Arrest) and HCC 213 (Cardio-Respiratory Failure and Shock).
ICD-10-CM Codes That Map to HCC 211 13 codes
- J95.00 Unspecified tracheostomy complication from V24 HCC 82
- J95.01 Hemorrhage from tracheostomy stoma from V24 HCC 82
- J95.02 Infection of tracheostomy stoma from V24 HCC 82
- J95.03 Malfunction of tracheostomy stoma from V24 HCC 82
- J95.04 Tracheo-esophageal fistula following tracheostomy from V24 HCC 82
- J95.09 Other tracheostomy complication from V24 HCC 82
- J95.850 Mechanical complication of respirator from V24 HCC 82
- J95.851 Ventilator associated pneumonia from V24 HCC 114
- J95.859 Other complication of respirator [ventilator] from V24 HCC 82
- Z43.0 Encounter for attention to tracheostomy from V24 HCC 82
- Z93.0 Tracheostomy status from V24 HCC 82
- Z99.11 Dependence on respirator [ventilator] status from V24 HCC 82
- Z99.12 Encounter for respirator [ventilator] dependence during power failure from V24 HCC 82
Every code above carries the full HCC 211 weight when documented and reported on a Medicare Advantage encounter. The code link opens its full page with the complete risk adjustment card.
Questions About HCC 211
What is HCC 211 in the CMS-HCC model?
HCC 211 is CMS-HCC Category 211 (Respirator Dependence/Tracheostomy Status/Complications) in the V28 risk adjustment model. It covers 13 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 211?
For payment year 2026, HCC 211 adds 0.879 to the RAF score of a community, non-dual, aged beneficiary (living at home, age 65 or over, not also enrolled in Medicaid). The published weights range from 0.590 to 1.981 across the seven payment segments shown above.
Related References
Source: Centers for Medicare & Medicaid Services, Payment Year 2026 risk adjustment mapping and model software releases (CMS-HCC V28), applied to the FY 2026 ICD-10-CM code set. ICD List is not affiliated with CMS.
