V28 HCC 224
Acute on Chronic Heart Failure
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 224 has a source-labeled community non-dual aged reference coefficient of 0.36, and 3 ICD-10-CM diagnosis codes appear in its official mapping. In the V28 hierarchy it is superseded by HCC 221, HCC 222, HCC 223 when a more severe category in the same disease group is also present.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.
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
Trumped by: HCC 221, HCC 222, HCC 223 (a more severe category in the same disease group supersedes this one).
Supersedes: 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 224 (3)
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.
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 224?
HCC 224 is "Acute on Chronic Heart Failure", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 3 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 224?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 224 is 0.36. 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 224?
3 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 224 (Acute on Chronic Heart Failure) for payment year 2026.
Which categories trump HCC 224 in the V28 hierarchy?
HCC 224 is superseded by HCC 221 (Heart Transplant Status/Complications), HCC 222 (End Stage Heart Failure), HCC 223 (Heart Assist Device/Artificial Heart). When a more severe category in the same disease group is documented, it is counted instead of HCC 224.
Related condition guides
In-depth HCC coding guides for conditions that map to category 224, 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.