V28 HCC 221
Heart Transplant Status/Complications
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 221 has a source-labeled community non-dual aged reference coefficient of 1.053, and 15 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 222, HCC 223, HCC 224, HCC 225, HCC 226, HCC 227 (this category is counted instead of these when they co-occur).
ICD-10-CM codes that map to HCC 221 (15)
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.
- T86.20Unspecified complication of heart transplant
- T86.21Heart transplant rejection
- T86.22Heart transplant failure
- T86.23Heart transplant infection
- T86.290Cardiac allograft vasculopathy
- T86.298Other complications of heart transplant
- T86.30Unspecified complication of heart-lung transplant
- T86.31Heart-lung transplant rejection
- T86.32Heart-lung transplant failure
- T86.33Heart-lung transplant infection
- T86.39Other complications of heart-lung transplant
- Z48.21Encounter for aftercare following heart transplant
- Z48.280Encounter for aftercare following heart-lung transplant
- Z94.1Heart transplant status
- Z94.3Heart and lungs transplant status
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 221?
HCC 221 is "Heart Transplant Status/Complications", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 15 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 221?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 221 is 1.053. 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 221?
15 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 221 (Heart Transplant Status/Complications) for payment year 2026.
Related condition guides
In-depth HCC coding guides for conditions that map to category 221, with documentation tips, common mistakes, and the V24-to-V28 changes.
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.