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. 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.
