Z94.0 ICD-10-CM Code: Kidney transplant status
HCC Buddy Code Card
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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
Z94.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceKidney transplant status
A person who has received a kidney transplant and the transplant is currently functioning.
Buddy Insight
This code represents successful kidney transplantation with current organ function, indicating resolution of end-stage renal disease but ongoing need for immunosuppressive therapy and transplant monitoring.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 183
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 260
Not separately weighted
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Z94.0 in this effective period.
Excludes 2
Official- presence of vascular grafts (Z95.-)
Related Child Codes
Includes
Official- organ or tissue replaced by heterogenous or homogenous transplant
Excludes 1
Official- complications of transplanted organ or tissue - see Alphabetical Index
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Z94.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Z94.0 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z94.0 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 Z94.0 an HCC code?
Z94.0 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Kidney Transplant Complications under the Part D RxHCC model.
- Code
- Z94.0
- Description
- Kidney transplant status
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- 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 Z94.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for Z94.0
For Z94.0 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 Z94.0 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
Z94.0 is the ICD-10-CM diagnosis code for kidney transplant status. A person who has received a kidney transplant and the transplant is currently functioning. Z94.0 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).
Z94.0 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing Z94.0 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z94.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Kidney transplant status, post-transplant with functioning allograft. Requires documentation that the patient has received a kidney transplant and retains functioning graft.
- •If the graft has failed and the patient is on dialysis, code N18.6 with Z99.2 and consider T86.1x (transplant complication). The status alone does not capture current failure.
- •Kidney transplant status (Z94.0) does not map to a V28 payment HCC; CMS dropped renal transplant status from the V28 payment model. Other organ transplant statuses still map (for example heart to HCC 221, lung to HCC 276, liver to HCC 62). Continue coding Z94.0 for clinical completeness even though it carries no risk weight.
Clinical Significance
This code represents successful kidney transplantation with current organ function, indicating resolution of end-stage renal disease but ongoing need for immunosuppressive therapy and transplant monitoring. These patients require lifelong specialized care to prevent rejection and manage medication-related complications.
Documentation Requirements
- ✓Confirmation of functioning kidney transplant
- ✓Date of transplant if available
- ✓Current transplant function status
- ✓Immunosuppressive medication regimen
- ✓Routine monitoring parameters
- ✓No current rejection or complications
- ✓Transplant-related follow-up care
- ✓Original indication for transplant