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Heart HCCs in CMS-HCC V28 (HCC 221-238)

The heart group of the CMS-HCC V28 model holds 10 payment categories (HCC 221, 222, 223, 224, 225, 226, 227, 228, 229, 238): heart transplant, heart failure, acute MI, unstable angina and arrhythmias. 139 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.189 (HCC 227) to 2.505 (HCC 223). 2 hierarchies rank HCC 221 > 222 > 223 > 224 > 225 > 226 > 227 and HCC 228 > 229, so a member is paid for at most one category in each chain.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); CMS-HCC V28 model software: CMS-HCC V28 software V2826.115.T2 (PY2027 initial) (payment year 2027). Next CMS release: PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027).

Payment categories
10
Mapped ICD-10-CM codes
139
Factor range (CNA)
0.189 to 2.505
Hierarchies in the group
2
CMS hierarchy group "Heart"

Categories and relative factors

Each factor is added to the member's demographic factors when the category is documented in the data collection year. Community, non-dual, aged (CNA) is the largest segment; the disabled (CND) and long-term institutional (INS) segments are estimated separately, which is why the same category is worth a different amount for each.

CMS-HCC V28 heart categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 221Heart Transplant Status/Complications151.0530.9990.840
HCC 222End-Stage Heart Failure12.5055.7700.826
HCC 223Heart Failure with Heart Assist Device/Artificial Heart62.5055.7700.826
HCC 224Acute on Chronic Heart Failure30.3600.4420.217
HCC 225Acute Heart Failure (Excludes Acute on Chronic)60.3600.4420.217
HCC 226Heart Failure, Except End-Stage and Acute340.3600.4420.217
HCC 227Cardiomyopathy/Myocarditis140.1890.2000.189
HCC 228Acute Myocardial Infarction180.2520.2540.310
HCC 229Unstable Angina and Other Acute Ischemic Heart Disease250.2400.2540.310
HCC 238Specified Heart Arrhythmias170.2990.2960.245

Hierarchy inside the group

The V28 hierarchy macro ranks related categories so that a member with codes in several of them is paid only for the higher-ranked one. Each category drops only the categories its own macro entry lists.

Read each chain left to right: every category drops every category to its right, so a member is paid for at most one category per chain.

  • HCC 221 (Heart Transplant Status/Complications) > HCC 222 (End-Stage Heart Failure) > HCC 223 (Heart Failure with Heart Assist Device/Artificial Heart) > HCC 224 (Acute on Chronic Heart Failure) > HCC 225 (Acute Heart Failure (Excludes Acute on Chronic)) > HCC 226 (Heart Failure, Except End-Stage and Acute) > HCC 227 (Cardiomyopathy/Myocarditis)
  • HCC 228 (Acute Myocardial Infarction) > HCC 229 (Unstable Angina and Other Acute Ischemic Heart Disease)

Interaction terms that involve this group

V28 pays an extra factor when two condition groups are documented together, on top of each category's own factor. A blank cell means the segment carries no such term.

V28 interaction factors involving heart categories
InteractionCNACNDINS
Diabetes and heart failure0.1120.0230.209
Disabled and heart failure (institutional)0.488
Heart failure and chronic lung disorder0.0780.0620.145
Heart failure and specified heart arrhythmias0.0770.257
Heart failure and kidney disease0.1760.3140.000

ICD-10-CM code families

Where the mapped codes concentrate. A family with many codes is usually where specificity matters most: the category only counts when the documented diagnosis supports the exact code reported.

Three-character ICD-10-CM categories with the most codes in the heart group
ICD-10-CM categoryMapped codes
I5023
I2113
I2712
T8611
I239
I429
I489
I258

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. 5 codes in this group had no V24 payment category. The main V24 sources are below; the crosswalk report covers every category.

V24 categories behind the heart V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
85Congestive Heart Failure57
86Acute Myocardial Infarction22
87Unstable Angina and Other Acute Ischemic Heart Disease21
96Specified Heart Arrhythmias17
186Major Organ Transplant or Replacement Status17
136Chronic Kidney Disease, Stage 51

The CMS-HCC V24 vs V28 crosswalk shows the codes that lost or gained payment status across all categories.

Inpatient MS-DRGs that use these diagnoses

Appendix B of the v44 MS-DRG Definitions Manual names the DRGs whose logic uses each diagnosis. The same documentation supports the inpatient group and, for Medicare Advantage members, the risk score.

MS-DRGs whose logic lists the most heart HCC codes
MS-DRGTitleShared codes
DRG 314Other Circulatory System Diagnoses with MCC55
DRG 315Other Circulatory System Diagnoses with CC55
DRG 316Other Circulatory System Diagnoses without CC/MCC55
DRG 791Prematurity with Major Problems40
DRG 793Full Term Neonate with Major Problems40
DRG 291Heart Failure and Shock with MCC27
DRG 292Heart Failure and Shock with CC27
DRG 293Heart Failure and Shock without CC/MCC27

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted 2 codes mapped to this group and created 6 replacement codes whose predecessors map here. CMS has not mapped the new codes yet; each category page lists them as pending. The FY2027 code changes report lists every new and deleted code.

Where QuickIntell fits for heart HCCs

An HCC counts only when the visit note supports it. QuickScribe captures the encounter documentation, and QuickCode supports qualified coder review and documentation clarification before diagnoses are submitted.

See QuickScribe for visit documentationSee QuickCode for coder reviewBook a meeting

Frequently asked questions

Which HCCs are in the V28 heart group?

HCC 221 (Heart Transplant Status/Complications, 15 codes, factor 1.053); HCC 222 (End-Stage Heart Failure, 1 codes, factor 2.505); HCC 223 (Heart Failure with Heart Assist Device/Artificial Heart, 6 codes, factor 2.505); HCC 224 (Acute on Chronic Heart Failure, 3 codes, factor 0.360); HCC 225 (Acute Heart Failure (Excludes Acute on Chronic), 6 codes, factor 0.360); HCC 226 (Heart Failure, Except End-Stage and Acute, 34 codes, factor 0.360); HCC 227 (Cardiomyopathy/Myocarditis, 14 codes, factor 0.189); HCC 228 (Acute Myocardial Infarction, 18 codes, factor 0.252); HCC 229 (Unstable Angina and Other Acute Ischemic Heart Disease, 25 codes, factor 0.240); HCC 238 (Specified Heart Arrhythmias, 17 codes, factor 0.299).

Which heart HCC has the most mapped ICD-10-CM codes?

HCC 226, Heart Failure, Except End-Stage and Acute, with 34 codes in the PY2027 initial mapping; across the group the largest code families are I50 (23), I21 (13), I27 (12), T86 (11).

Where did the heart codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 139 code-to-category links point to this group; 5 of those codes had no V24 payment category. The main V24 sources were HCC 85 (Congestive Heart Failure, 57), HCC 86 (Acute Myocardial Infarction, 22), HCC 87 (Unstable Angina and Other Acute Ischemic Heart Disease, 21).

Do heart HCCs interact with other conditions in V28?

Yes. Diabetes and heart failure adds 0.112 (community, non-dual, aged); Disabled and heart failure (institutional) adds 0.488 (long-term institutional only); Heart failure and chronic lung disorder adds 0.078 (community, non-dual, aged); Heart failure and specified heart arrhythmias adds 0.077 (community, non-dual, aged; the term exists only for community members); Heart failure and kidney disease adds 0.176 (community, non-dual, aged). Each term is added on top of the category factors when both conditions are documented.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Factors, hierarchies and mappings are reproduced from the CMS risk adjustment model files as an operational reference. The group is a navigation aid built from the V28 hierarchy; CMS pays categories, not groups. Payment depends on the plan's base rate, normalization, the coding intensity adjustment and the enrollee's segment. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.