Z95.811
BillablePresence of heart assist device
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z95.811 an HCC code?
Yes. Z95.811 maps to LVAD/Heart Assist Device/Artificial Heart under the CMS-HCC V28 risk adjustment model (and Major Organ Transplant or Replacement Status under V24).
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 Z95.811
For Z95.811 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 Z95.811 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z95.811 is the ICD-10-CM diagnosis code for presence of heart assist device. A patient who has a mechanical device surgically implanted to help the heart pump blood to the body in cases of severe heart failure. Z95.811 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, Z95.811 maps to LVAD/Heart Assist Device/Artificial Heart (HCC 223) with a community, non-dual, aged base RAF weight of 0.000. Under the older CMS-HCC V24 model, Z95.811 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.
Specify the type of assist device (LVAD, RVAD, BiVAD, or ECMO) in documentation for clarity. Because Z95.811 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 Z95.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify the type of assist device (LVAD, RVAD, BiVAD, or ECMO) in documentation for clarity
- •Use with heart failure codes to provide complete clinical picture; monitor for device-related complications
Clinical Significance
This code represents the presence of a mechanical cardiac assist device that supports heart function in patients with severe heart failure, indicating extremely high mortality risk and complex care needs. These devices require specialized monitoring, anticoagulation management, and infection prevention protocols.
Documentation Requirements
- ✓Confirmation of heart assist device presence
- ✓Type of device (LVAD, RVAD, BiVAD)
- ✓Device manufacturer and model if available
- ✓Current device function and parameters
- ✓Anticoagulation management
- ✓Device-related care requirements
- ✓Monitoring protocols and complications
- ✓Bridge to transplant vs destination therapy