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Respiratory failure and arrest HCCs in CMS-HCC V28 (HCC 211-213)

The respiratory failure and arrest group of the CMS-HCC V28 model holds 3 payment categories (HCC 211, 212, 213): respirator dependence, respiratory arrest and cardio-respiratory failure. 51 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.370 (HCC 212) to 0.879 (HCC 211). One hierarchy ranks HCC 211 > 212 > 213, so a member is paid for at most one category in the 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
3
Mapped ICD-10-CM codes
51
Factor range (CNA)
0.370 to 0.879
Hierarchies in the group
1
CMS hierarchy group "Arrest"

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 respiratory failure and arrest categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 211Respirator Dependence/Tracheostomy Status/Complications130.8790.8781.570
HCC 212Respiratory Arrest20.3700.5100.258
HCC 213Cardio-Respiratory Failure and Shock360.3700.5100.258

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 211 (Respirator Dependence/Tracheostomy Status/Complications) > HCC 212 (Respiratory Arrest) > HCC 213 (Cardio-Respiratory Failure and Shock)

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 respiratory failure and arrest categories
InteractionCNACNDINS
Chronic lung disorder and cardio-respiratory failure0.2540.2420.331

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 respiratory failure and arrest group
ICD-10-CM categoryMapped codes
J9612
J959
P286
P264
P274
I463
I492
R572

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. 16 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 respiratory failure and arrest V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
84Cardio-Respiratory Failure and Shock21
82Respirator Dependence/Tracheostomy Status12
83Respiratory Arrest1
114Aspiration and Specified Bacterial Pneumonias1

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 respiratory failure and arrest HCC codes
MS-DRGTitleShared codes
DRG 791Prematurity with Major Problems17
DRG 793Full Term Neonate with Major Problems17
DRG 189Pulmonary Edema and Respiratory Failure14
DRG 205Other Respiratory System Diagnoses with MCC10
DRG 206Other Respiratory System Diagnoses without MCC10
DRG 928Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC9
DRG 929Full Thickness Burn with Skin Graft or Inhalation Injury without CC/MCC9
DRG 934Full Thickness Burn without Skin Graft or Inhalation Injury9

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted no code mapped to this group, so its code lists carry into FY2027 unchanged until CMS posts a mapping for the new code set. The FY2027 code changes report lists every new and deleted code.

Where QuickIntell fits for respiratory failure and arrest 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 respiratory failure and arrest group?

HCC 211 (Respirator Dependence/Tracheostomy Status/Complications, 13 codes, factor 0.879); HCC 212 (Respiratory Arrest, 2 codes, factor 0.370); HCC 213 (Cardio-Respiratory Failure and Shock, 36 codes, factor 0.370).

Which respiratory failure and arrest HCC has the most mapped ICD-10-CM codes?

HCC 213, Cardio-Respiratory Failure and Shock, with 36 codes in the PY2027 initial mapping; across the group the largest code families are J96 (12), J95 (9), P28 (6), P26 (4).

Where did the respiratory failure and arrest codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 51 code-to-category links point to this group; 16 of those codes had no V24 payment category. The main V24 sources were HCC 84 (Cardio-Respiratory Failure and Shock, 21), HCC 82 (Respirator Dependence/Tracheostomy Status, 12), HCC 83 (Respiratory Arrest, 1).

Do respiratory failure and arrest HCCs interact with other conditions in V28?

Yes. Chronic lung disorder and cardio-respiratory failure adds 0.254 (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.