HCC 213: Cardio-Respiratory Failure and Shock ICD-10-CM
CMS-HCC Category 213 (Cardio-Respiratory Failure and Shock) 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). 36 ICD-10-CM diagnosis codes map to HCC 213. A more severe related category (HCC 211 and HCC 212) 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) and HCC 212 (Respiratory Arrest) supersede HCC 213 when reported together.
ICD-10-CM Codes That Map to HCC 213 36 codes
- I46.2 Cardiac arrest due to underlying cardiac condition from V24 HCC 84
- I46.8 Cardiac arrest due to other underlying condition from V24 HCC 84
- I46.9 Cardiac arrest, cause unspecified from V24 HCC 84
- I49.01 Ventricular fibrillation from V24 HCC 84
- I49.02 Ventricular flutter from V24 HCC 84
- J80 Acute respiratory distress syndrome from V24 HCC 84
- J81.0 Acute pulmonary edema from V24 HCC 84
- J96.00 Acute respiratory failure, unspecified whether with hypoxia or hypercapnia from V24 HCC 84
- J96.01 Acute respiratory failure with hypoxia from V24 HCC 84
- J96.02 Acute respiratory failure with hypercapnia from V24 HCC 84
- J96.10 Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia from V24 HCC 84
- J96.11 Chronic respiratory failure with hypoxia from V24 HCC 84
- J96.12 Chronic respiratory failure with hypercapnia from V24 HCC 84
- J96.20 Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia from V24 HCC 84
- J96.21 Acute and chronic respiratory failure with hypoxia from V24 HCC 84
- J96.22 Acute and chronic respiratory failure with hypercapnia from V24 HCC 84
- J96.90 Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia from V24 HCC 84
- J96.91 Respiratory failure, unspecified with hypoxia from V24 HCC 84
- J96.92 Respiratory failure, unspecified with hypercapnia from V24 HCC 84
- P22.0 Respiratory distress syndrome of newborn new to V28
- P26.0 Tracheobronchial hemorrhage originating in the perinatal period new to V28
- P26.1 Massive pulmonary hemorrhage originating in the perinatal period new to V28
- P26.8 Other pulmonary hemorrhages originating in the perinatal period new to V28
- P26.9 Unspecified pulmonary hemorrhage originating in the perinatal period new to V28
- P27.0 Wilson-Mikity syndrome new to V28
- P27.1 Bronchopulmonary dysplasia originating in the perinatal period new to V28
- P27.8 Other chronic respiratory diseases originating in the perinatal period new to V28
- P27.9 Unspecified chronic respiratory disease originating in the perinatal period new to V28
- P28.0 Primary atelectasis of newborn new to V28
- P28.10 Unspecified atelectasis of newborn new to V28
- P28.11 Resorption atelectasis without respiratory distress syndrome new to V28
- P28.19 Other atelectasis of newborn new to V28
- P28.5 Respiratory failure of newborn new to V28
- P29.81 Cardiac arrest of newborn new to V28
- R57.0 Cardiogenic shock from V24 HCC 84
- R57.9 Shock, unspecified from V24 HCC 84
Every code above carries the full HCC 213 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 213
What is HCC 213 in the CMS-HCC model?
HCC 213 is CMS-HCC Category 213 (Cardio-Respiratory Failure and Shock) in the V28 risk adjustment model. It covers 36 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 213?
For payment year 2026, HCC 213 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 213?
HCC 211 (Respirator Dependence/Tracheostomy Status/Complications) and HCC 212 (Respiratory Arrest) sit above HCC 213 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.
