Z95.812
BillablePresence of fully implantable artificial heart
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z95.812 an HCC code?
Yes. Z95.812 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 Z95.812
For Z95.812 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 Z95.812 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z95.812 is the ICD-10-CM diagnosis code for presence of fully implantable artificial heart. A patient who has had a fully implantable artificial heart surgically placed to replace the function of a failing natural heart. Z95.812 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, Z95.812 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, Z95.812 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 is a rare code used for total artificial heart (TAH) implants; ensure documentation clearly indicates a fully implantable device. Because Z95.812 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 Z95.812 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a rare code used for total artificial heart (TAH) implants; ensure documentation clearly indicates a fully implantable device
- •Combine with severe heart failure codes and monitor closely for device malfunction or rejection
Clinical Significance
This code represents the presence of a completely implantable artificial heart that replaces natural cardiac function, indicating survival from end-stage heart failure with extremely high ongoing mortality risk. These patients require the most intensive cardiac monitoring and specialized care protocols.
Documentation Requirements
- ✓Confirmation of fully implantable artificial heart
- ✓Device manufacturer and model
- ✓Current device function and parameters
- ✓Power source and battery management
- ✓Anticoagulation protocols
- ✓Specialized monitoring requirements
- ✓Device-related complications or concerns
- ✓Bridge to transplant vs permanent therapy