HCC 212: Respiratory Arrest ICD-10-CM
CMS-HCC Category 212 (Respiratory Arrest) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.258 and 0.662 to a beneficiary's RAF score depending on the payment segment (0.370 for a community, non-dual, aged enrollee). 2 ICD-10-CM diagnosis codes map to HCC 212. A more severe related category (HCC 211) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.370 |
| Community, partial-benefit dual, aged | 0.409 |
| Community, full-benefit dual, aged | 0.573 |
| Community, non-dual, disabled | 0.510 |
| Community, partial-benefit dual, disabled | 0.493 |
| Community, full-benefit dual, disabled | 0.662 |
| Institutional | 0.258 |
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. In the hierarchy, HCC 211 (Respirator Dependence/Tracheostomy Status/Complications) supersedes HCC 212 when reported together. HCC 212 in turn supersedes HCC 213 (Cardio-Respiratory Failure and Shock).
ICD-10-CM Codes That Map to HCC 212 2 codes
Questions About HCC 212
What is HCC 212 in the CMS-HCC model?
HCC 212 is CMS-HCC Category 212 (Respiratory Arrest) in the V28 risk adjustment model. It covers 2 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 212?
For payment year 2026, HCC 212 adds 0.370 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 0.258 to 0.662 across the seven payment segments shown above.
Which categories supersede HCC 212?
HCC 211 (Respirator Dependence/Tracheostomy Status/Complications) sits above HCC 212 in the hierarchy: when a beneficiary has diagnoses in both, only the more severe category is paid.
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.
