Heart Assist Device/Artificial Heart
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 223 carries a community non-dual aged RAF of 2.505, and 6 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 221, HCC 222 when a more severe category in the same disease group is also present.
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.
V28 hierarchy
Trumped by: HCC 221, HCC 222 (a more severe category in the same disease group supersedes this one).
Supersedes: 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 223 (6)
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.
- T82.512ABreakdown (mechanical) of artificial heart, initial encounter
- T82.522ADisplacement of artificial heart, initial encounter
- T82.532ALeakage of artificial heart, initial encounter
- T82.592AOther mechanical complication of artificial heart, initial encounter
- Z95.811Presence of heart assist device
- Z95.812Presence of fully implantable artificial heart
Frequently asked questions
What is CMS-HCC V28 category 223?
HCC 223 is "Heart Assist Device/Artificial Heart", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 6 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 223?
The community non-dual aged relative factor for CMS-HCC V28 category 223 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 223?
6 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 223 (Heart Assist Device/Artificial Heart) for payment year 2026.
Which categories trump HCC 223 in the V28 hierarchy?
HCC 223 is superseded by HCC 221 (Heart Transplant Status/Complications), HCC 222 (End Stage Heart Failure). When a more severe category in the same disease group is documented, it is counted instead of HCC 223.
Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.