Z94.3
BillableHeart and lungs transplant status
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z94.3 an HCC code?
Yes. Z94.3 maps to Major Organ Transplant or Replacement Status under the V24 model but is not retained in V28.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for Z94.3
For Z94.3 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 Z94.3 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z94.3 is the ICD-10-CM diagnosis code for heart and lungs transplant status. A person who has received both a heart and lung transplant as a combined procedure and the transplants are currently functioning. Z94.3 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).
Under the older CMS-HCC V24 model, Z94.3 maps to Major Organ Transplant or Replacement Status (HCC 186) with a community, non-dual, aged base RAF weight of 0.910. 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.
This code represents a single combined procedure; do not use with both Z94.1 and Z94.2 simultaneously. Because Z94.3 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 Z94.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
This code represents successful combined heart and lung transplantation, indicating survival from end-stage cardiopulmonary disease requiring the most complex organ transplant procedure. These patients have extremely high ongoing mortality risk and require intensive immunosuppressive therapy and specialized monitoring.
Documentation Requirements
- ✓Confirmation of functioning combined heart-lung transplant
- ✓Date of combined transplant procedure
- ✓Current cardiac and pulmonary function
- ✓Complex immunosuppressive regimen
- ✓Specialized monitoring protocols
- ✓No current rejection of either organ
- ✓Combined transplant program follow-up
- ✓Original indication for combined procedure