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V28 HCC 226Community non-dual aged RAF 0.36

Heart Failure, Except End Stage and Acute

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 226 carries a community non-dual aged RAF of 0.36, and 34 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 221, HCC 222, HCC 223, HCC 224, HCC 225 when a more severe category in the same disease group is also present.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.

Community NA: 0.36Community PBA: 0.311Community FBA: 0.406Community ND: 0.442Community PBD: 0.411Community FBD: 0.537Institutional: 0.217

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, HCC 222, HCC 223, HCC 224, HCC 225 (a more severe category in the same disease group supersedes this one).

Supersedes: HCC 227 (this category is counted instead of these when they co-occur).

ICD-10-CM codes that map to HCC 226 (34)

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 226: 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 226?

HCC 226 is "Heart Failure, Except End Stage and Acute", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 34 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 226?

The community non-dual aged relative factor for CMS-HCC V28 category 226 is 0.36. 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 226?

34 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 226 (Heart Failure, Except End Stage and Acute) for payment year 2026.

Which categories trump HCC 226 in the V28 hierarchy?

HCC 226 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), HCC 225 (Acute Heart Failure (Excludes Acute on Chronic)). When a more severe category in the same disease group is documented, it is counted instead of HCC 226.

Related condition guides

In-depth HCC coding guides for conditions that map to category 226, with documentation tips, common mistakes, and the V24-to-V28 changes.

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.