End Stage Heart Failure
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 222 carries a community non-dual aged RAF of 2.505, and 1 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 221 when a more severe category in the same disease group is also present.
Medically reviewed by Jess P., CPC · Reviewed: May 30, 2026
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.
Combine this factor with demographics and other HCCs in the RAF score calculator to model the full CMS-HCC V28 RAF for a member.
V28 hierarchy
Trumped by: HCC 221 (a more severe category in the same disease group supersedes this one).
Supersedes: 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 222 (1)
Payable diagnosis codes that map to this category under CMS-HCC V28 PY2026. Open any code for its full description, HCC mapping, and coding guidance.
Coder workflow notes
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A printable one-pager for HCC 222: which member codes risk-adjust, the RAF weight, and the MEAT your notes need to make it stick. Free, no card.
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Frequently asked questions
What is CMS-HCC V28 category 222?
HCC 222 is "End Stage Heart Failure", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 1 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 222?
The community non-dual aged relative factor for CMS-HCC V28 category 222 is 2.505. The exact factor varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 Rate Announcement.
How many ICD-10-CM codes map to HCC 222?
1 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 222 (End Stage Heart Failure) for payment year 2026.
Which categories trump HCC 222 in the V28 hierarchy?
HCC 222 is superseded by HCC 221 (Heart Transplant Status/Complications). When a more severe category in the same disease group is documented, it is counted instead of HCC 222.
Related references
Sources
CMS published ICD-10-CM mapping file plus 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.