Dementia HCC Coding Guide
Dementia (e.g. G30.0) maps to HCC 127 (Dementia, Mild or Unspecified) under the CMS-HCC V28 risk adjustment model, with a community, non-dual, aged RAF weight of 0.341; V28 reached 100% phase-in for payment year 2026. F01.51, vascular dementia, unspecified severity, with behavioral disturbance, is non-HCC under V28.
Complete HCC coding guide for Dementia (F01-F03) including Alzheimer's, vascular, and other dementias with ICD-10 to HCC mapping, V28 RAF weights, and documentation tips.
Medically reviewed by Jess P., CPC · Reviewed: May 10, 2026 · Updated for CMS-HCC V28 and FY2026 ICD-10-CM
Quick Facts
HCC Categories
HCC 127, Dementia, Mild or Unspecified
RAF Weight Range
0.341
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
9 ICD-10 codes map to payment HCCs
What HCC category does Dementia map to under V28?
Dementia covers a group of progressive neurocognitive disorders affecting roughly 7 million Americans, with Alzheimer's disease the most common type. Under CMS-HCC V28, the common unspecified-severity dementia codes (for example F03.90 unspecified dementia, F01.50 vascular dementia, and F02.80 dementia in diseases classified elsewhere) all map to HCC 127, Dementia, Mild or Unspecified, which carries a community non-dual aged RAF of 0.341. The underlying etiology codes also land in HCC 127, so Alzheimer's disease (G30.x) and dementia with Lewy bodies (G31.83) both group to the same category. Accurate coding still requires specifying the dementia type, the documented severity, and any behavioral disturbance, supported by cognitive assessment results and functional status. Capture co-occurring delirium when documented.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| F01.50 | Vascular dementia, unspecified severity, without behavioral disturbance | Yes | HCC 127 |
| F01.511 | Vascular dementia, unspecified severity, with agitation | Yes | HCC 127 |
| F02.80 | Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance | Yes | HCC 127 |
| F02.811 | Dementia in other diseases classified elsewhere, unspecified severity, with agitation | Yes | HCC 127 |
| F03.90 | Unspecified dementia, unspecified severity, without behavioral disturbance | Yes | HCC 127 |
| G30.0 | Alzheimer's disease with early onset | Yes | HCC 127 |
| G30.1 | Alzheimer's disease with late onset | Yes | HCC 127 |
| G30.9 | Alzheimer's disease, unspecified | Yes | HCC 127 |
| G31.83 | Dementia with Lewy bodies | Yes | HCC 127 |
| F01.51 | Vascular dementia, unspecified severity, with behavioral disturbance | Yes | No HCC (not risk-adjusting under V28) |
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS rate announcement for payment calculations.
HCC Buddy maps Dementia from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Documentation Tips
Document the specific type of dementia: Alzheimer's (G30 + F02), vascular (F01), Lewy body (G31.83 + F02), frontotemporal (G31.09 + F02).
Specify the severity of dementia: mild, moderate, or severe based on cognitive assessment tools (MMSE, MoCA).
Document any behavioral disturbances: agitation, wandering, aggression, or psychotic symptoms, these affect code selection.
For Alzheimer's disease, always code both the Alzheimer's etiology (G30.x) and the dementia manifestation (F02.x).
Include the most recent cognitive assessment score and date to support the documented severity level.
Record the patient's functional status (ADLs/IADLs) to support the severity documentation.
Document current medications including cholinesterase inhibitors and memantine to satisfy MEAT treatment criteria.
Note caregiver involvement and any advance directive discussions as part of the care plan.
Common Coding Mistakes
Coding F03.90 (unspecified dementia) when the type and etiology are documented, always code to the specific type.
Forgetting to code both the Alzheimer's disease code (G30.x) and the dementia manifestation code (F02.x), both are required.
Not capturing behavioral disturbances when they are documented, missing the opportunity for more specific coding.
Failing to document dementia severity, which is required under V28 for proper HCC stratification between HCC 149 and HCC 150.
V24 to V28 Changes
V28 reorganized the dementia family. Under the prior V24 model, dementia collapsed into a single dementia category regardless of severity. V28 restructured these conditions into severity-stratified categories, and the widely used unspecified-severity codes (F01.x, F02.8x, F03.90) now map to HCC 127, Dementia, Mild or Unspecified, with a community non-dual aged RAF of 0.341. Because severity is now a model dimension, documentation that specifies mild, moderate, or severe dementia matters for landing a record in the correct dementia HCC. Note that the Alzheimer's etiology codes (G30.x) and Lewy body dementia (G31.83) also group to HCC 127, so both the etiology and the manifestation contribute to the same category rather than separate ones.
Related Conditions
Related references
Sources
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS Rate Announcement for payment.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 10, 2026.
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