V28 HCC 211
Respirator Dependence/Tracheostomy Status/Complications
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 211 has a source-labeled community non-dual aged reference coefficient of 0.879, and 13 ICD-10-CM diagnosis codes appear in its official mapping.
RAF factors
The community factor varies by Medicaid and originally-disabled status; the institutional factor applies to long-term-institutional members. These are the CMS-HCC V28 PY2026 relative factors.
These are source-labeled code-level HCC coefficient references, not a full member score. Use the RAF Calculator with complete member context for CMS-HCC V28 PY2026. No score is shown unless every required source and calculation check passes.
V28 hierarchy
Supersedes: HCC 212, HCC 213 (this category is counted instead of these when they co-occur).
ICD-10-CM codes that map to HCC 211 (13)
ICD-10-CM codes in the official mapping for this category under CMS-HCC V28 PY2026. Open any code for its full description and coding guidance.
- J95.00Unspecified tracheostomy complication
- J95.01Hemorrhage from tracheostomy stoma
- J95.02Infection of tracheostomy stoma
- J95.03Malfunction of tracheostomy stoma
- J95.04Tracheo-esophageal fistula following tracheostomy
- J95.09Other tracheostomy complication
- J95.850Mechanical complication of respirator
- J95.851Ventilator associated pneumonia
- J95.859Other complication of respirator [ventilator]
- Z43.0Encounter for attention to tracheostomy
- Z93.0Tracheostomy status
- Z99.11Dependence on respirator [ventilator] status
- Z99.12Encounter for respirator [ventilator] dependence during power failure
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 211?
HCC 211 is "Respirator Dependence/Tracheostomy Status/Complications", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 13 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 211?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 211 is 0.879. The exact coefficient varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 model files.
How many ICD-10-CM codes map to HCC 211?
13 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 211 (Respirator Dependence/Tracheostomy Status/Complications) for payment year 2026.
Related references
Sources
CMS ICD-10-CM order-file billability plus the published mapping and CMS-HCC V28 PY2026 model software. CMS-HCC V28 model published at CMS.gov Risk Adjustors; ICD-10-CM member codes from the CMS ICD-10-CM code set.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 30, 2026.