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. 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.
