FY2027 ICD-10-CM reference
I11.0: Hypertensive heart disease with heart failure
By the HCC Buddy Coding Team
The official ICD-10-CM descriptor is Hypertensive heart disease with heart failure. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Billable code. Verified against the official FY2027 order file.
CMS-HCC V28
- HCC 226: Heart Failure, Except End Stage and Acute · RAF 0.360, Community Non-Dual Aged (CNA)
Payment year 2027, 2026 dates of service. HCC from the CMS 2027 Initial ICD-10-CM Mappings; RAF from the CMS-HCC V28 relative factors. For 2027 dates of service, CMS has not yet published the payment year 2028 mappings.
CMS-HCC V24
Not used for payment year 2027 Medicare Advantage payment
ESRD
- HCC 85: Congestive Heart Failure
Coefficient pending: payment year 2027 coefficients for this model are not yet verified, so no RAF is shown. Mapping: PY2026 CMS mapping; CMS 2027 initial file unchanged.
PACE
Source verification pending
RxHCC
- HCC 186: Heart Failure
Coefficient pending: payment year 2027 coefficients for this model are not yet verified, so no RAF is shown. Mapping: PY2026 CMS mapping; CMS 2027 initial file unchanged.
HHS-HCC
- HCC 130: Heart Failure
RAF not applicable: HHS-HCC weights vary by metal level. Mapping: HHS-HCC 2026 benefit year.
FY2027 Tabular instructions
Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.
Excludes2
certain conditions originating in the perinatal period (P04-P96)
Source: I00-I99 (chapter, inherited).
Excludes2
certain infectious and parasitic diseases (A00-B99)
Source: I00-I99 (chapter, inherited).
Excludes2
complications of pregnancy, childbirth and the puerperium (O00-O9A)
Source: I00-I99 (chapter, inherited).
Excludes2
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
Source: I00-I99 (chapter, inherited).
Excludes2
endocrine, nutritional and metabolic diseases (E00-E88)
Source: I00-I99 (chapter, inherited).
Excludes2
injury, poisoning and certain other consequences of external causes (S00-T88)
Source: I00-I99 (chapter, inherited).
Excludes2
neoplasms (C00-D49)
Source: I00-I99 (chapter, inherited).
Excludes2
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Source: I00-I99 (chapter, inherited).
Excludes2
systemic connective tissue disorders (M30-M36)
Source: I00-I99 (chapter, inherited).
Excludes2
transient cerebral ischemic attacks and related syndromes (G45.-)
Source: I00-I99 (chapter, inherited).
Instructional note
code to identify:
Source: I10-I1A (section, inherited).
Instructional note
exposure to environmental tobacco smoke (Z77.22)
Source: I10-I1A (section, inherited).
Instructional note
history of tobacco dependence (Z87.891)
Source: I10-I1A (section, inherited).
Instructional note
occupational exposure to environmental tobacco smoke (Z57.31)
Source: I10-I1A (section, inherited).
Instructional note
tobacco dependence (F17.-)
Source: I10-I1A (section, inherited).
Instructional note
tobacco use (Z72.0)
Source: I10-I1A (section, inherited).
Excludes1
neonatal hypertension (P29.2)
Source: I10-I1A (section, inherited).
Excludes1
primary pulmonary hypertension (I27.0)
Source: I10-I1A (section, inherited).
Excludes2
hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)
Source: I10-I1A (section, inherited).
Includes
any condition in I50.- or I51.4-I51.7, I51.89, I51.9 due to hypertension
Source: I11 (category, inherited).
Instructional note
Hypertensive heart failure
Source: I11.0 (self, direct).
Instructional note
code to identify type of heart failure (I50.-)
Source: I11.0 (self, direct).
Compare the FY2027 additions, removals and billable-status changes
What does I11.0 mean in FY2027?
The official ICD-10-CM descriptor is Hypertensive heart disease with heart failure. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Is I11.0 billable in FY2027?
The FY2027 order file marks I11.0 as billable. Check the complete Tabular instructions and documentation before assigning it.
Does I11.0 map to an HCC?
In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), I11.0 maps to CMS-HCC V28 HCC 226 (Heart Failure, Except End Stage and Acute). For 2027 dates of service, CMS has not yet published the payment year 2028 mappings. Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: ESRD HCC 85; RxHCC HCC 186. Coefficients for these models are pending verification for payment year 2027. HHS-HCC: HCC 130 under the HHS-HCC 2026 benefit year mapping (no RAF; HHS-HCC weights vary by metal level). CMS-HCC V24: not used for payment year 2027 Medicare Advantage payment (CMS CY 2027 Rate Announcement). The PACE mapping is still pending verification for FY2027.
Source: CMS FY2027 ICD-10-CM order file. Payment model: CMS CY 2027 Rate Announcement. Read the FY2027 Official Guidelines.
Review the FY2026 April edition