Most status Z codes earn nothing in risk adjustment. A handful carry a real payment HCC under CMS-HCC V28. Here are the ones that map, and the status codes coders think map but don't.

Most status Z codes earn nothing in risk adjustment, but a handful carry a real payment HCC under CMS-HCC V28. The ones that map are organ transplant status, ventilator and tracheostomy dependence, feeding-tube status, major limb amputation, and asymptomatic HIV status. The trap runs the other direction too: a few status codes coders assume still count were dropped in V28 or were never in the model at all.

This list is for coders working problem lists and status sections who need to know which Z codes pull an HCC and which are documentation-only. Every mapping below was checked against the current CMS V28 payment model. Status codes are still secondary codes. Report them as the status they describe, supported by the record, not as a stand-in for an active diagnosis.

Current as of June 2026. Payment year 2026 runs 100% on the CMS-HCC V28 model, so every mapping below is the V28 result.

Key takeaways

Most status Z codes earn nothing. A handful carry a real payment HCC under V28.

The ones that map: organ transplant status (heart Z94.1, lung Z94.2, liver Z94.4, bone marrow Z94.81, intestine Z94.82, pancreas Z94.83), ventilator and tracheostomy dependence (Z99.11, Z93.0), gastrostomy status (Z93.1), major limb amputation (the Z89.5x and Z89.6x codes), and asymptomatic HIV (Z21).

The traps: kidney transplant status (Z94.0) and dialysis dependence (Z99.2) are scored in the kidney and ESRD context, not the community V28 model. History-of codes, long-term oxygen, cardiac-device status, and minor (toe) amputation carry no V28 payment HCC.

A status code is not a diagnosis. The record has to support the status, and the documentation rules for HIV and history-of codes still apply.

1. Organ transplant status

A patient living with a transplanted organ carries that status as a real, ongoing risk factor, and V28 pays for most of it. Z94.1 (heart) maps to HCC 221, Z94.2 (lung) to HCC 276, Z94.4 (liver) to HCC 62, Z94.81 (bone marrow) to HCC 454, Z94.82 (intestine) to HCC 77, and Z94.83 (pancreas) to HCC 35.

The one that surprises coders: Z94.0 (kidney transplant status) does not map to a community V28 HCC. Kidney transplant status is handled in CMS's kidney and ESRD scoring, not the community model that pays most members, so coding Z94.0 expecting a community HCC comes up empty.

2. Ventilator and tracheostomy dependence

Long-term ventilator dependence is one of the highest-acuity status codes a coder sees, and V28 recognizes it. Z99.11 (dependence on respirator/ventilator status) maps to HCC 211. Z93.0 (tracheostomy status) maps to the same HCC 211.

The chart has to show an actual ventilator or tracheostomy the patient lives with, not a transient in-hospital event. A ventilator-dependent patient, documented at every encounter it is true, is one of the more valuable secondary captures in a complex panel.

3. Gastrostomy and feeding-tube status

Z93.1 (gastrostomy status) maps to V28 HCC 463. A patient who relies on a feeding tube carries that status until it is reversed.

Document it as current, not historical. "History of feeding tube placement" does not support Z93.1 the way "patient has a gastrostomy" does, and once the tube is removed the status no longer applies. The simple check: if the tube is still there and feeding the patient, it belongs in the code. It is easy to miss because the feeding tube is rarely the reason for the visit.

4. Major limb amputation status

Acquired absence of a leg above or below the knee maps under V28. Above-knee codes in the Z89.61 series (for example Z89.611) and below-knee codes in the Z89.51 series (for example Z89.511) carry HCC 409.

The trap here is partial. Minor amputation status, a toe (the Z89.41 series), mapped under V24 but was dropped in V28. So "amputation status" is not a single answer anymore. A major limb still carries an HCC. A toe does not.

5. Asymptomatic HIV status

Z21 (asymptomatic HIV infection status) maps to V28 HCC 1, the same HCC as B20 (HIV disease). Same HCC does not make them interchangeable. Z21 is for a patient who is HIV-positive without a current HIV-related illness, and B20 is for HIV disease. Coding B20 when only asymptomatic status is documented is an overcoding finding, even though the risk score is unchanged. Code the one the record supports, and follow the confirmation rules in the Official Guidelines for HIV coding.

Status codes coders think map but don't under V28

These come up again and again in QA. They are valid codes. They just carry no community V28 payment HCC.

Kidney transplant status (Z94.0) and dialysis dependence (Z99.2) are scored in the kidney and ESRD context, not the community model. See item 1.

History-of cancer codes (the Z85 family, for example Z85.3 for breast) and Z86.73 (history of TIA or stroke without residual deficits) describe a resolved condition, not an active one, so they carry no HCC. History is not the active disease. Z85 itself is a category header, not a billable code.

Long-term oxygen (Z99.81) and wheelchair dependence (Z99.3) are supportive status codes with no payment HCC.

Cardiac and vascular device status, like Z95.1 (aortocoronary bypass) and Z95.5 (coronary angioplasty implant and graft), carries no V28 HCC.

Acquired absence of an organ (the Z90 series) and minor amputation (the Z89.41 series) carry no community V28 payment HCC.

If a status code is on your tip sheet as an HCC and it is in this list, check the current CMS mapping before you rely on it. See ICD-10 codes that do not map to HCC for the broader reference.

At a glance

Status code	Describes	V28 HCC	Maps under V28?
Z94.1	Heart transplant status	221	Yes
Z94.4	Liver transplant status	62	Yes
Z94.83	Pancreas transplant status	35	Yes
Z99.11	Ventilator dependence	211	Yes
Z93.0	Tracheostomy status	211	Yes
Z93.1	Gastrostomy status	463	Yes
Z89.61 series	Above-knee amputation status	409	Yes
Z21	Asymptomatic HIV status	1	Yes
Z94.0	Kidney transplant status	None (kidney/ESRD context)	No
Z99.2	Dialysis dependence	None (ESRD context)	No
Z85 family	History of cancer	None	No
Z86.73	History of TIA/stroke	None	No
Z95.5	Coronary stent status	None	No
Z89.41 series	Toe/finger amputation status	None (dropped in V28)	No

Frequently asked questions

Do status Z codes count for risk adjustment?

Most do not, but several do. Organ transplant status (except kidney), ventilator and tracheostomy dependence, gastrostomy status, major limb amputation, and asymptomatic HIV status all carry a payment HCC under V28. The majority of status Z codes carry none.

Why doesn't kidney transplant status (Z94.0) map like the other transplants?

Kidney transplant and dialysis are scored in CMS's kidney and ESRD context, not the community V28 model that pays for most Medicare Advantage members. The other organ transplant status codes do map in the community model.

Does history of cancer (Z85) carry an HCC?

No. A history-of code describes a condition that is no longer active. Active malignancy still maps, but Z85 codes do not. Coding history-of cancer as if it were active is a common overcoding finding.

Did amputation status change under V28?

Yes. Major limb amputation (above or below the knee) still carries HCC 409. Minor amputation status, such as a toe, mapped under V24 but was dropped in V28.

Can I report Z79.4 (long-term insulin) to get the diabetes HCC?

No. Long-term insulin use appears on the V28 diabetes-HCC list, but the Official Guidelines treat it as a secondary code that cannot be reported without the underlying diabetes diagnosis. Code and recapture the diabetes itself. The insulin code supports it; it does not replace it.

Disclaimer

This article is for professional and educational use only. It is not coding, billing, legal, or medical advice. Verify every code and HCC mapping against the current official CMS, ICD-10-CM, and AHA Coding Clinic guidance and your payer's policy before you assign it. Reading it creates no provider, patient, or advisory relationship.