I50.1 ICD-10-CM Code: Left ventricular failure, unspecified
I50.1 maps to CMS-HCC V28 226 (RAF 0.360). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Other forms of heart disease (I30-I5A)
I50.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLeft ventricular failure, unspecified
Weakness of the left side of the heart that prevents it from pumping blood effectively to the body, leading to fluid buildup and fatigue.
Buddy Insight
Left ventricular failure, unspecified, indicates the heart's left ventricle cannot pump blood effectively to the body.
CMS-HCC V28
MappedHCC 226
RAF 0.360
CMS-HCC V24
MappedHCC 85
RAF 0.331
ACA/HHS
MappedHCC 130
Varies by metal level
ESRD/PACE
MappedHCC 85
RAF 0.063
RXHCC
MappedHCC 186
RAF 0.110
Code Book Path
Inclusion Terms
Official- Cardiac asthma
- Edema of lung with heart disease NOS
- Edema of lung with heart failure
- Left heart failure
- Pulmonary edema with heart disease NOS
Excludes 2
Official- cardiac arrest (I46.-)
- neonatal cardiac failure (P29.0)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for I50.1 in this effective period.
Excludes 1
Official- edema of lung without heart disease or heart failure (J81.-)
- pulmonary edema without heart disease or failure (J81.-)
Code First
Official- heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8)
- heart failure due to hypertension (I11.0)
- heart failure due to hypertension with chronic kidney disease (I13.-)
- heart failure following surgery (I97.13-)
- obstetric surgery and procedures (O75.4)
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for I50.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for I50.1 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is I50.1 an HCC code?
Yes. I50.1 (Left ventricular failure, unspecified) maps to Heart Failure, Except End Stage and Acute under the CMS-HCC V28 risk adjustment model (and Congestive Heart Failure under V24), with a community non-dual aged RAF of 0.360. It is billable for payment year 2026.
Coder answer: I50.1 is billable and maps to V28 HCC 226, Heart Failure, Except End Stage and Acute. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- I50.1
- Description
- Left ventricular failure, unspecified
- HCC (V28)
- HCC 226 — Heart Failure, Except End Stage and Acute
- RAF
- 0.360
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work I50.1 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I50.1
For I50.1 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed I50.1 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
I50.1 is the ICD-10-CM diagnosis code for left ventricular failure, unspecified. Weakness of the left side of the heart that prevents it from pumping blood effectively to the body, leading to fluid buildup and fatigue. I50.1 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering other forms of heart disease (i30-i5a).
Under the CMS-HCC V28 risk adjustment model, I50.1 maps to Heart Failure, Except End Stage and Acute (HCC 226) with a community, non-dual, aged base RAF weight of 0.360. Under the older CMS-HCC V24 model, I50.1 maps to Congestive Heart Failure (HCC 85) with a community, non-dual, aged base RAF weight of 0.331. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Verify whether systolic, diastolic, or combined dysfunction is documented; I50.1 is unspecified, so more specific codes may be available. Because I50.1 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for I50.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify whether systolic, diastolic, or combined dysfunction is documented; I50.1 is unspecified, so more specific codes may be available
- •Document ejection fraction if available, as this helps determine severity and guides treatment
Clinical Significance
Left ventricular failure, unspecified, indicates the heart's left ventricle cannot pump blood effectively to the body. This is a significant risk adjustment condition associated with high morbidity, frequent hospitalizations, and substantial healthcare resource utilization. Specificity should always be sought regarding systolic vs diastolic dysfunction and acuity.
Documentation Requirements
- ✓Provider must document left ventricular failure or heart failure as an active diagnosis
- ✓Ejection fraction if available to help determine systolic vs diastolic type
- ✓New York Heart Association functional class or equivalent functional status assessment
- ✓Current heart failure medications (diuretics, ACE inhibitors/ARBs, beta-blockers, aldosterone antagonists)
- ✓Acuity — whether acute, chronic, or acute on chronic
- ✓Signs and symptoms such as dyspnea, edema, orthopnea, jugular venous distension
Excludes 1, Do NOT code together
Commonly Confused Codes
- •I50.20: Unspecified systolic heart failure: use when systolic dysfunction is specifically documented
- •I50.30: Unspecified diastolic heart failure: use when diastolic dysfunction (preserved ejection fraction) is documented
- •I50.40: Unspecified combined systolic and diastolic heart failure: use when both types are documented
- •I50.9: Heart failure, unspecified: even less specific, use only as last resort
- •I11.0: Hypertensive heart disease with heart failure: use when heart failure is due to hypertension, with additional I50.- code