HCC 227: Cardiomyopathy/Myocarditis ICD-10-CM
CMS-HCC Category 227 (Cardiomyopathy/Myocarditis) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.145 and 0.200 to a beneficiary's RAF score depending on the payment segment (0.189 for a community, non-dual, aged enrollee). 14 ICD-10-CM diagnosis codes map to HCC 227. A more severe related category (HCC 221, HCC 222, HCC 223, HCC 224, HCC 225, and HCC 226) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.189 |
| Community, partial-benefit dual, aged | 0.145 |
| Community, full-benefit dual, aged | 0.173 |
| Community, non-dual, disabled | 0.200 |
| Community, partial-benefit dual, disabled | 0.186 |
| Community, full-benefit dual, disabled | 0.198 |
| Institutional | 0.189 |
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), HCC 223 (Heart Assist Device/Artificial Heart), HCC 224 (Acute on Chronic Heart Failure), HCC 225 (Acute Heart Failure (Excludes Acute on Chronic)), and HCC 226 (Heart Failure, Except End Stage and Acute) supersede HCC 227 when reported together.
ICD-10-CM Codes That Map to HCC 227 14 codes
- A36.81 Diphtheritic cardiomyopathy from V24 HCC 85
- B33.24 Viral cardiomyopathy from V24 HCC 85
- I42.0 Dilated cardiomyopathy from V24 HCC 85
- I42.1 Obstructive hypertrophic cardiomyopathy from V24 HCC 85
- I42.2 Other hypertrophic cardiomyopathy from V24 HCC 85
- I42.3 Endomyocardial (eosinophilic) disease from V24 HCC 85
- I42.4 Endocardial fibroelastosis from V24 HCC 85
- I42.5 Other restrictive cardiomyopathy from V24 HCC 85
- I42.6 Alcoholic cardiomyopathy from V24 HCC 85
- I42.8 Other cardiomyopathies from V24 HCC 85
- I42.9 Cardiomyopathy, unspecified from V24 HCC 85
- I43 Cardiomyopathy in diseases classified elsewhere from V24 HCC 85
- I51.4 Myocarditis, unspecified from V24 HCC 85
- I51.5 Myocardial degeneration from V24 HCC 85
Every code above carries the full HCC 227 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 227
What is HCC 227 in the CMS-HCC model?
HCC 227 is CMS-HCC Category 227 (Cardiomyopathy/Myocarditis) in the V28 risk adjustment model. It covers 14 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 227?
For payment year 2026, HCC 227 adds 0.189 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.145 to 0.200 across the seven payment segments shown above.
Which categories supersede HCC 227?
HCC 221 (Heart Transplant Status/Complications), 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)), and HCC 226 (Heart Failure, Except End Stage and Acute) sit above HCC 227 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.
