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V28 HCC 226

Heart Failure, Except End Stage and Acute

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 226 has a source-labeled community non-dual aged reference coefficient of 0.36, and 34 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 In the V28 hierarchy it is superseded by HCC 221, HCC 222, HCC 223, HCC 224, HCC 225 when a more severe category in the same disease group is also present.

By the HCC Buddy Coding Team · Reviewed: May 30, 2026
V28 HCC 226Community non-dual aged reference coefficient 0.36
See ICD-10-CM codes for HCC 226Open the RAF Calculator

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

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, 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)

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 226?

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

What reference coefficient is published for HCC 226?

The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 226 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 226?

34 ICD-10-CM diagnosis codes appear in the official mapping for 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 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.