Organ Transplant Status HCC Coding Guide
Organ Transplant Status (e.g. Z94.4) maps to HCC 62 (Liver Transplant Status/Complications) under the CMS-HCC V28 risk adjustment model, with a community, non-dual, aged RAF weight of 0.376; V28 reached 100% phase-in for payment year 2026. Z94.0, kidney transplant status, is non-HCC under V28. It can also map to HCC 276 (Lung Transplant Status/Complications) and HCC 221 (Heart Transplant Status/Complications) when the documentation supports those manifestations.
Complete HCC coding guide for Organ Transplant Status (Z94.x) including ICD-10 to HCC mapping, V28 RAF weights, immunosuppression documentation, and transplant complication coding.
Medically reviewed by Jess P., CPC · Reviewed: May 9, 2026 · Updated for CMS-HCC V28 and FY2026 ICD-10-CM
Quick Facts
HCC Categories
HCC 276, Lung Transplant Status/Complications
HCC 221, Heart Transplant Status/Complications
HCC 35, Pancreas Transplant Status
HCC 62, Liver Transplant Status/Complications
RAF Weight Range
0.376 to 2.531
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
7 ICD-10 codes map to payment HCCs
What HCC category does Organ Transplant Status map to under V28?
Organ transplant status reflects the ongoing complexity and lifelong immunosuppression that transplant recipients require. A key V28 reality is that transplant status does not map to one shared category. Each organ routes to its own CMS-HCC V28 HCC, so the Z94.x status code (and any matching T86.x complication) drives a different RAF depending on the organ. Lung transplant status maps to HCC 276 (community non-dual aged RAF 2.531), heart to HCC 221 (RAF 1.053), pancreas to HCC 35 (RAF 0.949), and liver to HCC 62 (RAF 0.376). Coders must report the Z94.x status at every encounter, specify the transplanted organ, and pair it with transplant complications (T86.x) when present. Capture the underlying condition that led to the transplant when it remains active and clinically relevant.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| Z94.0 | Kidney transplant status | Yes | No HCC (not risk-adjusting under V28) |
| Z94.1 | Heart transplant status | Yes | HCC 221 |
| Z94.2 | Lung transplant status | Yes | HCC 276 |
| Z94.3 | Heart and lungs transplant status | Yes | HCC 276 |
| Z94.4 | Liver transplant status | Yes | HCC 62 |
| Z94.83 | Pancreas transplant status | Yes | HCC 35 |
| T86.10 | Unspecified complication of kidney transplant | Yes | No HCC (not risk-adjusting under V28) |
| T86.11 | Kidney transplant rejection | Yes | No HCC (not risk-adjusting under V28) |
| T86.21 | Heart transplant rejection | Yes | HCC 221 |
| T86.41 | Liver transplant rejection | Yes | HCC 62 |
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS rate announcement for payment calculations.
HCC Buddy maps Organ Transplant Status from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Documentation Tips
Report the transplant status code (Z94.x) at every encounter, it must be recaptured annually for risk adjustment.
Document the specific organ transplanted: kidney, heart, lung, liver, pancreas, or combination.
Record current immunosuppressive medications (tacrolimus, mycophenolate, prednisone) to satisfy MEAT treatment criteria.
Code transplant complications (T86.x) separately when documented: rejection, failure, infection.
Document lab monitoring: tacrolimus levels, renal function for kidney transplant, liver function for liver transplant.
Note the date of transplant and the transplant center for continuity of care documentation.
If CKD persists after kidney transplant, code both Z94.0 and the appropriate CKD stage.
Common Coding Mistakes
Failing to code transplant status at every encounter, Z94.x must be reported annually for risk adjustment capture.
Not coding transplant complications (T86.x) separately when rejection, failure, or infection is documented.
Missing the immunosuppressive drug therapy code (Z79.899) as a supporting code for long-term medication documentation.
Forgetting to code the original disease (CKD, heart failure, cirrhosis) if it remains relevant after transplant.
V24 to V28 Changes
The biggest V28 shift is that organ transplant status no longer rolls up into a single shared transplant category. V28 splits recognition by organ, so each transplant routes to its own HCC instead of one combined code. Lung transplant status maps to HCC 276, heart (and heart-lung) to HCC 221, pancreas to HCC 35, and liver to HCC 62, each carrying its own RAF weight that ranges from roughly 0.376 (liver) up to 2.531 (lung). This means organ specificity now directly drives the score, so a vague or non-specific status code can cost real RAF. The practical message is unchanged in spirit, document the specific organ and recapture the Z94.x status every year, but V28 makes that specificity matter more than ever.
Related Conditions
Related references
Sources
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS Rate Announcement for payment.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 9, 2026.
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