HCC 224: Acute on Chronic Heart Failure ICD-10-CM
CMS-HCC Category 224 (Acute on Chronic Heart Failure) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.217 and 0.537 to a beneficiary's RAF score depending on the payment segment (0.360 for a community, non-dual, aged enrollee). 3 ICD-10-CM diagnosis codes map to HCC 224. A more severe related category (HCC 221, HCC 222, and HCC 223) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.360 |
| Community, partial-benefit dual, aged | 0.311 |
| Community, full-benefit dual, aged | 0.406 |
| Community, non-dual, disabled | 0.442 |
| Community, partial-benefit dual, disabled | 0.411 |
| Community, full-benefit dual, disabled | 0.537 |
| Institutional | 0.217 |
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), HCC 222 (End Stage Heart Failure), and HCC 223 (Heart Assist Device/Artificial Heart) supersede HCC 224 when reported together. HCC 224 in turn supersedes 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 224 3 codes
- I50.23 Acute on chronic systolic (congestive) heart failure from V24 HCC 85
- I50.33 Acute on chronic diastolic (congestive) heart failure from V24 HCC 85
- I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure from V24 HCC 85
Every code above carries the full HCC 224 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 224
What is HCC 224 in the CMS-HCC model?
HCC 224 is CMS-HCC Category 224 (Acute on Chronic Heart Failure) in the V28 risk adjustment model. It covers 3 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 224?
For payment year 2026, HCC 224 adds 0.360 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.217 to 0.537 across the seven payment segments shown above.
Which categories supersede HCC 224?
HCC 221 (Heart Transplant Status/Complications), HCC 222 (End Stage Heart Failure), and HCC 223 (Heart Assist Device/Artificial Heart) sit above HCC 224 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.
