V28 HCC 227
Cardiomyopathy/Myocarditis
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 227 has a source-labeled community non-dual aged reference coefficient of 0.189, and 14 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 In the V28 hierarchy it is superseded by HCC 221, HCC 222, HCC 223, HCC 224, HCC 225, HCC 226 when a more severe category in the same disease group is also present.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, HCC 225, HCC 226 (a more severe category in the same disease group supersedes this one).
ICD-10-CM codes that map to HCC 227 (14)
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.
- A36.81Diphtheritic cardiomyopathy
- B33.24Viral cardiomyopathy
- I42.0Dilated cardiomyopathy
- I42.1Obstructive hypertrophic cardiomyopathy
- I42.2Other hypertrophic cardiomyopathy
- I42.3Endomyocardial (eosinophilic) disease
- I42.4Endocardial fibroelastosis
- I42.5Other restrictive cardiomyopathy
- I42.6Alcoholic cardiomyopathy
- I42.8Other cardiomyopathies
- I42.9Cardiomyopathy, unspecified
- I43Cardiomyopathy in diseases classified elsewhere
- I51.4Myocarditis, unspecified
- I51.5Myocardial degeneration
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 227?
HCC 227 is "Cardiomyopathy/Myocarditis", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 14 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 227?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 227 is 0.189. 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 227?
14 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 227 (Cardiomyopathy/Myocarditis) for payment year 2026.
Which categories trump HCC 227 in the V28 hierarchy?
HCC 227 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)), HCC 226 (Heart Failure, Except End Stage and Acute). When a more severe category in the same disease group is documented, it is counted instead of HCC 227.
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.