HCC 221: Heart Transplant Status/Complications ICD-10-CM
CMS-HCC Category 221 (Heart Transplant 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 0.840 and 1.781 to a beneficiary's RAF score depending on the payment segment (1.053 for a community, non-dual, aged enrollee). 15 ICD-10-CM diagnosis codes map to HCC 221. 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 | 1.053 |
| Community, partial-benefit dual, aged | 0.880 |
| Community, full-benefit dual, aged | 1.412 |
| Community, non-dual, disabled | 0.999 |
| Community, partial-benefit dual, disabled | 1.371 |
| Community, full-benefit dual, disabled | 1.781 |
| Institutional | 0.840 |
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 221 in turn supersedes HCC 222 (End Stage Heart Failure), HCC 223 (Heart Assist Device/Artificial Heart), HCC 224 (Acute on Chronic Heart Failure), HCC 225 (Acute Heart Failure (Excludes Acute on Chronic)), HCC 226 (Heart Failure, Except End Stage and Acute), and HCC 227 (Cardiomyopathy/Myocarditis).
ICD-10-CM Codes That Map to HCC 221 15 codes
- T86.20 Unspecified complication of heart transplant from V24 HCC 186
- T86.21 Heart transplant rejection from V24 HCC 186
- T86.22 Heart transplant failure from V24 HCC 186
- T86.23 Heart transplant infection from V24 HCC 186
- T86.290 Cardiac allograft vasculopathy from V24 HCC 186
- T86.298 Other complications of heart transplant from V24 HCC 186
- T86.30 Unspecified complication of heart-lung transplant from V24 HCC 186
- T86.31 Heart-lung transplant rejection from V24 HCC 186
- T86.32 Heart-lung transplant failure from V24 HCC 186
- T86.33 Heart-lung transplant infection from V24 HCC 186
- T86.39 Other complications of heart-lung transplant from V24 HCC 186
- Z48.21 Encounter for aftercare following heart transplant from V24 HCC 186
- Z48.280 Encounter for aftercare following heart-lung transplant from V24 HCC 186
- Z94.1 Heart transplant status from V24 HCC 186
- Z94.3 Heart and lungs transplant status from V24 HCC 186
Every code above carries the full HCC 221 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 221
What is HCC 221 in the CMS-HCC model?
HCC 221 is CMS-HCC Category 221 (Heart Transplant Status/Complications) in the V28 risk adjustment model. It covers 15 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 221?
For payment year 2026, HCC 221 adds 1.053 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.840 to 1.781 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.
