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FY2027 ICD-10-CM reference

I50.89: Other heart failure

By the HCC Buddy Coding Team

The official ICD-10-CM descriptor is Other 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).

Code first

heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8)

Source: I50 (category, inherited).

Code first

heart failure due to hypertension (I11.0)

Source: I50 (category, inherited).

Code first

heart failure due to hypertension with chronic kidney disease (I13.-)

Source: I50 (category, inherited).

Code first

heart failure following surgery (I97.13-)

Source: I50 (category, inherited).

Code first

obstetric surgery and procedures (O75.4)

Source: I50 (category, inherited).

Code first

rheumatic heart failure (I09.81)

Source: I50 (category, inherited).

Excludes2

cardiac arrest (I46.-)

Source: I50 (category, inherited).

Excludes2

neonatal cardiac failure (P29.0)

Source: I50 (category, inherited).

Source: CMS FY2027 Tabular List and Alphabetic Index.

Open Tabular instructions and code details

Compare the FY2027 additions, removals and billable-status changes

What does I50.89 mean in FY2027?

The official ICD-10-CM descriptor is Other 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 I50.89 billable in FY2027?

The FY2027 order file marks I50.89 as billable. Check the complete Tabular instructions and documentation before assigning it.

Does I50.89 map to an HCC?

In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), I50.89 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