Z94.83 ICD-10-CM Code: Pancreas transplant status
Z94.83 maps to CMS-HCC V28 35 (RAF 0.949). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software
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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)
Z94.83
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePancreas transplant status
A person who has received a pancreas transplant, typically to manage diabetes by restoring insulin production.
Buddy Insight
This code represents successful pancreas transplantation with current organ function, typically performed for diabetes management or combined with kidney transplant.
CMS-HCC V28
MappedHCC 35
RAF 0.949
CMS-HCC V24
MappedHCC 186
RAF 0.832
ACA/HHS
MappedHCC 18
Varies by metal level
ESRD/PACE
MappedHCC 186
RAF 0.138
RXHCC
MappedHCC 396
Not separately weighted
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Z94.83 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Z94.83 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Z94.83 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Z94.83 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Z94.83 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Z94.83 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z94.83 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 Z94.83 an HCC code?
Yes. Z94.83 (Pancreas transplant status) maps to Pancreas Transplant Status under the CMS-HCC V28 risk adjustment model (and Major Organ Transplant or Replacement Status under V24), with a community non-dual aged RAF of 0.949. It is billable for payment year 2026.
Coder answer: Z94.83 is billable and maps to V28 HCC 35, Pancreas Transplant Status. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- Z94.83
- Description
- Pancreas transplant status
- HCC (V28)
- HCC 35 — Pancreas Transplant Status
- RAF
- 0.949
- 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 Z94.83 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for Z94.83
For Z94.83 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 Z94.83 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
Z94.83 is the ICD-10-CM diagnosis code for pancreas transplant status. A person who has received a pancreas transplant, typically to manage diabetes by restoring insulin production. Z94.83 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 CMS-HCC V28 risk adjustment model, Z94.83 maps to Pancreas Transplant Status (HCC 35) with a community, non-dual, aged base RAF weight of 0.949. Under the older CMS-HCC V24 model, Z94.83 maps to Major Organ Transplant or Replacement Status (HCC 186) with a community, non-dual, aged base RAF weight of 0.832. 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.
Pancreas transplant status, post-pancreatic-transplant. Often concurrent with kidney transplant in diabetic patients (simultaneous kidney-pancreas, SPK). Because Z94.83 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 Z94.83 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Pancreas transplant status, post-pancreatic-transplant. Often concurrent with kidney transplant in diabetic patients (simultaneous kidney-pancreas, SPK).
- •Pair with Z94.0 when both organs were transplanted. Both codes can be reported together.
- •V28 HCC 35 (Pancreas Transplant Status) at RAF 0.949.
Clinical Significance
This code represents successful pancreas transplantation with current organ function, typically performed for diabetes management or combined with kidney transplant. These patients require ongoing immunosuppressive therapy and monitoring for both transplant rejection and diabetes complications.
Documentation Requirements
- ✓Confirmation of functioning pancreas transplant
- ✓Type of transplant (pancreas alone, simultaneous kidney-pancreas)
- ✓Date of transplant if available
- ✓Current glucose control and C-peptide levels
- ✓Immunosuppressive medication regimen
- ✓Monitoring for rejection and complications
- ✓Endocrinology transplant follow-up
- ✓Diabetes management status post-transplant