FY2027 ICD-10-CM reference
Z94.1: Heart transplant status
By the HCC Buddy Coding Team
The official ICD-10-CM descriptor is Heart transplant status. 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 221: Heart Transplant Status/Complications · RAF 1.053, 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 186: Major Organ Transplant or Replacement Status
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 396: Heart, Lung, Liver, Intestine, or Pancreas Transplant Status
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 129: Heart Transplant Status/Complications
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.
Instructional note
Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
Source: Z00-Z99 (chapter, inherited).
Instructional note
(a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
Source: Z00-Z99 (chapter, inherited).
Instructional note
(b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
Source: Z00-Z99 (chapter, inherited).
Code also
any follow-up examination (Z08-Z09)
Source: Z77-Z99 (section, inherited).
Includes
organ or tissue replaced by heterogenous or homogenous transplant
Source: Z94 (category, inherited).
Excludes1
complications of transplanted organ or tissue - see Alphabetical Index
Source: Z94 (category, inherited).
Excludes2
presence of vascular grafts (Z95.-)
Source: Z94 (category, inherited).
Excludes1
artificial heart status (Z95.812)
Source: Z94.1 (self, direct).
Excludes1
heart-valve replacement status (Z95.2-Z95.4)
Source: Z94.1 (self, direct).
Compare the FY2027 additions, removals and billable-status changes
What does Z94.1 mean in FY2027?
The official ICD-10-CM descriptor is Heart transplant status. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Is Z94.1 billable in FY2027?
The FY2027 order file marks Z94.1 as billable. Check the complete Tabular instructions and documentation before assigning it.
Does Z94.1 map to an HCC?
In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), Z94.1 maps to CMS-HCC V28 HCC 221 (Heart Transplant Status/Complications). 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 186; RxHCC HCC 396. Coefficients for these models are pending verification for payment year 2027. HHS-HCC: HCC 129 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