Cardiomyopathy/Myocarditis
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 227 carries a community non-dual aged RAF of 0.189, and 14 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 In the V28 hierarchy it is superseded by HCC 221, HCC 222, HCC 223, HCC 224, HCC 225, HCC 226 when a more severe category in the same disease group is also present.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.
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)
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.
- 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
Frequently asked questions
What is CMS-HCC V28 category 227?
HCC 227 is "Cardiomyopathy/Myocarditis", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 14 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 227?
The community non-dual aged relative factor for CMS-HCC V28 category 227 is 0.189. 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 227?
14 payable ICD-10-CM diagnosis codes map to 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HCC 227 is superseded by HCC 221 (Heart Transplant Status/Complications), HCC 222 (End Stage Heart Failure), HCC 223 (Heart Assist Device/Artificial Heart), HCC 224 (Acute on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.
Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.