V28 HCC 225
Acute Heart Failure (Excludes Acute on Chronic)
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 225 has a source-labeled community non-dual aged reference coefficient of 0.36, and 6 ICD-10-CM diagnosis codes appear in its official mapping. In the V28 hierarchy it is superseded by HCC 221, HCC 222, HCC 223, HCC 224 when a more severe category in the same disease group is also present.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, HCC 224 (a more severe category in the same disease group supersedes this one).
Supersedes: HCC 226, HCC 227 (this category is counted instead of these when they co-occur).
ICD-10-CM codes that map to HCC 225 (6)
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 225?
HCC 225 is "Acute Heart Failure (Excludes Acute on Chronic)", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 6 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 225?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 225 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 225?
6 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 225 (Acute Heart Failure (Excludes Acute on Chronic)) for payment year 2026.
Which categories trump HCC 225 in the V28 hierarchy?
HCC 225 is superseded by HCC 221 (Heart Transplant Status/Complications), HCC 222 (End Stage Heart Failure), HCC 223 (Heart Assist Device/Artificial Heart), HCC 224 (Acute on Chronic Heart Failure). When a more severe category in the same disease group is documented, it is counted instead of HCC 225.
Related condition guides
In-depth HCC coding guides for conditions that map to category 225, 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.