ICD-10 Z94.1
Billable / Specific HCC v28: 186 CCHeart transplant status
About ICD-10-CM Z94.1
ICD-10-CM code Z94.1 represents Heart transplant status. This is a billable/specific code in the Factors Influencing Health Status chapter (block Z94). The 2026 edition of ICD-10-CM Z94.1 became effective on October 1, 2025.
Coding Tips for Z94.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Z94.1 is a CMS-HCC v28 risk-adjustment code (category 186). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Z94.1 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 1 Excludes
Pure excludes, these codes can never be coded together with Z94.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- artificial heart status (Z95.812)
- heart-valve replacement status (Z95.2-Z95.4)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Heart transplant status. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for Z94.1
Local Coverage Determinations (LCDs) from CMS MACs that list Z94.1 as a covered diagnosis.
Showing top 10 of 1,852 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing Z94.1.
1 Aetna
5 Medicare
CPT Codes Commonly Billed with Z94.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 0544U CMS LCD: Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection CMS LCD
- 0509U CMS LCD: Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection CMS LCD
- 0508U CMS LCD: Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection CMS LCD
- 93798 CMS LCD: Billing and Coding: Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac Rehabilitation CMS LCD
- 93797 CMS LCD: Billing and Coding: Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac Rehabilitation CMS LCD
- G0423 CMS LCD: Billing and Coding: Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac Rehabilitation CMS LCD
- G0422 CMS LCD: Billing and Coding: Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac Rehabilitation CMS LCD
Convert Z94.1 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| Z94.1 | V421 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To Z94.1
Other codes in section Z77-Z99 (Persons with potential health hazards related to family and personal history and certain conditions influencing health status).
ICD-10 Z94.1, Billing FAQ
Is ICD-10 code Z94.1 billable? +
Yes, Z94.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for Z94.1? +
Type 1 Excludes (never code together with Z94.1): artificial heart status (Z95.812); heart-valve replacement status (Z95.2-Z95.4)
Does Z94.1 affect Medicare Advantage HCC risk adjustment? +
Yes. Z94.1 maps to CMS-HCC v28 category 186. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is Z94.1 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with Z94.1? +
Procedures frequently paired with Z94.1 include: 0544U, 0509U, 0508U, 93798, 93797.
What ICD-9 codes does Z94.1 map to? +
Per CMS GEMs, Z94.1 maps to ICD-9 codes: V421. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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