HCC 223: Heart Assist Device/Artificial Heart ICD-10-CM
CMS-HCC Category 223 (Heart Assist Device/Artificial Heart) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.826 and 6.612 to a beneficiary's RAF score depending on the payment segment (2.505 for a community, non-dual, aged enrollee). 6 ICD-10-CM diagnosis codes map to HCC 223. A more severe related category (HCC 221 and HCC 222) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 2.505 |
| Community, partial-benefit dual, aged | 3.009 |
| Community, full-benefit dual, aged | 2.927 |
| Community, non-dual, disabled | 5.770 |
| Community, partial-benefit dual, disabled | 6.106 |
| Community, full-benefit dual, disabled | 6.612 |
| Institutional | 0.826 |
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 221 (Heart Transplant Status/Complications) and HCC 222 (End Stage Heart Failure) supersede HCC 223 when reported together. HCC 223 in turn supersedes 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 223 6 codes
- T82.512A Breakdown (mechanical) of artificial heart, initial encounter new to V28
- T82.522A Displacement of artificial heart, initial encounter new to V28
- T82.532A Leakage of artificial heart, initial encounter new to V28
- T82.592A Other mechanical complication of artificial heart, initial encounter new to V28
- Z95.811 Presence of heart assist device from V24 HCC 186
- Z95.812 Presence of fully implantable artificial heart from V24 HCC 186
Every code above carries the full HCC 223 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 223
What is HCC 223 in the CMS-HCC model?
HCC 223 is CMS-HCC Category 223 (Heart Assist Device/Artificial Heart) in the V28 risk adjustment model. It covers 6 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 223?
For payment year 2026, HCC 223 adds 2.505 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.826 to 6.612 across the seven payment segments shown above.
Which categories supersede HCC 223?
HCC 221 (Heart Transplant Status/Complications) and HCC 222 (End Stage Heart Failure) sit above HCC 223 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.
