Condition guide
Dementia HCC Coding Guide
Dementia (e.g. G30.0) maps to HCC 127 (Dementia, Mild or Unspecified) under CMS-HCC V28. Its source-labeled community non-dual aged reference coefficient is 0.341. This is not a member total; full contribution depends on hierarchy, cleanup, interactions, member context, and model year. F01.51, vascular dementia, unspecified severity, with behavioral disturbance, is non-HCC under V28. It can also map to HCC 126 (Dementia, Moderate) and HCC 125 (Dementia, Severe) when the documentation supports those manifestations.
Quick Facts
HCC Categories
HCC 127, Dementia, Mild or Unspecified
HCC 126, Dementia, Moderate
HCC 125, Dementia, Severe
RAF Weight Range
0.341
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
12 ICD-10 codes map to payment HCCs
How coders write it
Chart notes, problem lists, and queries rarely spell out Dementia. The shorthand you will actually see:
Whatever the note calls it, the payment question is the same: how the ICD-10-CM code resolves to a payment HCC.
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 |
| F03.A0 | Unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | Yes | HCC 127 |
| F03.B0 | Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | Yes | HCC 126 |
| F03.C0 | Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | Yes | HCC 125 |
| F01.51 | Vascular dementia, unspecified severity, with behavioral disturbance | No | Not billable since FY2023: report F01.511 (agitation) or F01.518 (other behavioral disturbance), which carry the unspecified-severity category above |
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verify Dementia against the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coder workflow notes
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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 as part of the treatment review.
Note caregiver involvement and any advance directive discussions as part of the care plan.
MEAT documentation examples for Dementia
These examples organize documentation review using the MEAT review mnemonic for Dementia. Follow the applicable coding, encounter, program and payer requirements; these examples do not establish reportability on their own.
MMonitor
“MoCA 18/30 today, down from 22/30 last year; caregiver reports new wandering at night.”
“Sundowning most evenings per daughter; no falls since the last visit.”
EEvaluate
“Needs cueing for dressing and medication set-up; independent with feeding (ADL review documented).”
“Depression screen negative; B12 and TSH reviewed as reversible causes and normal.”
AAssess
“Alzheimer's disease with moderate dementia, progressing over the past year.”
“Vascular dementia, unspecified severity, with agitation; behavior worse since the hospital stay.”
TTreat
“Continue donepezil 10 mg; add memantine 5 mg daily and titrate.”
“Home safety evaluation ordered; caregiver referred to the Alzheimer's Association respite program.”
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 under V28 determines whether the record lands in HCC 127 (mild or unspecified), HCC 126 (moderate), or HCC 125 (severe).
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.
| Aspect | V24 (through PY2025) | V28 (PY2026) |
|---|---|---|
| Unspecified severity, no behavioral disturbance (F03.90, F01.50, G30.9 with F02.80) | HCC 52, Dementia Without Complication, RAF 0.346 | HCC 127, Dementia, Mild or Unspecified, RAF 0.341 |
| With behavioral disturbance (F03.911, F03.93, F01.511) | HCC 51, Dementia With Complications, RAF 0.346 | HCC 127 at unspecified severity, RAF 0.341; severity, not behavior, moves the category |
| Documented moderate severity (F03.B0, F01.B0, F02.B0) | No severity tier; HCC 52 or HCC 51 by behavior | HCC 126, Dementia, Moderate, RAF 0.341 |
| Documented severe (F03.C0, F01.C0, F02.C0) | No severity tier; HCC 52 or HCC 51 by behavior | HCC 125, Dementia, Severe, RAF 0.341 |
| What the tiers change for PY2026 | Two categories split on behavior | Three categories split on documented severity; the CNA reference coefficient is the same 0.341 in all three, so the tier is a documentation and hierarchy fact, not a community-segment payment gap |
These values are community, non-dual, aged code-level coefficient references for each model's payment year, not full member scores. For CMS-HCC V28 PY2026 member scoring with complete context, open the RAF Calculator. No score is shown unless every required source and calculation check passes.
Dementia coding FAQs
What does dementia CMS HCC mean?
It means the documented dementia code maps to one of three CMS-HCC V28 categories: HCC 127 (Dementia, Mild or Unspecified), HCC 126 (Dementia, Moderate), or HCC 125 (Dementia, Severe). The tier follows the severity the provider documents, which is carried in the fifth character of the F01, F02, and F03 codes (A mild, B moderate, C severe, 9 unspecified). Behavioral disturbance changes the code, not the category.
How do you code senile dementia?
The ICD-10-CM Index sends senile dementia to F03.9- (unspecified dementia). Report F03.90 when no severity or behavioral disturbance is documented, or the F03.A-, F03.B-, or F03.C- code when the provider states mild, moderate, or severe. Senility alone without dementia is R41.81 (age-related cognitive decline), which carries no payment HCC.
Can you code Alzheimer's and dementia together?
Yes, and you must. Alzheimer's disease is the etiology (G30.0, G30.1, G30.8, or G30.9, sequenced first) and the dementia is the manifestation (an F02.8- or F02.A- through F02.C- code with the documented severity and behavior). Both codes map to HCC 127, 126, or 125 depending on the severity documented; the hierarchy keeps only the highest tier.
What are the combination codes for dementia?
Since FY2023 the dementia codes carry severity and behavior in one code: the fifth character states severity (9 unspecified, A mild, B moderate, C severe) and the sixth character states the disturbance (0 none, 11 agitation, 18 other behavioral, 2 psychotic, 3 mood, 4 anxiety). F03.911 is unspecified dementia, unspecified severity, with agitation; F01.B0 is vascular dementia, moderate, without disturbance. Pick the code that matches every element the provider documented.
What are the ICD-10 codes for dementia?
Vascular dementia is F01.-, dementia in a disease classified elsewhere (Alzheimer's, Parkinson's, Lewy body) is F02.- reported after the etiology code, and unspecified dementia is F03.-. Alzheimer's disease itself is G30.-, and dementia with Lewy bodies is G31.83 with F02.-. All of them map to a CMS-HCC V28 dementia category; mild cognitive impairment (G31.84) does not.
Related Conditions
Related references
CMS-HCC V28 model
How V28 categories, source-labeled coefficient references, and hierarchy work for PY2026.
ICD-10 to HCC mapping
How an ICD-10-CM code resolves to a payment HCC under V28.
MEAT criteria
The documentation standard every coded condition must satisfy.
Every F02 code (Dementia in other diseases classified elsewhere)
24 billable codes, 24 with a CMS-HCC V28 category, in one table.
Every F03 code (Unspecified dementia)
24 billable codes, 24 with a CMS-HCC V28 category, in one table.
Every G30 code (Alzheimer's disease)
4 billable codes, 4 with a CMS-HCC V28 category, in one table.
Every G31 code (Other degenerative diseases of nervous system, not elsewhere classified)
14 billable codes, 7 with a CMS-HCC V28 category, in one table.
Sources
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed September 5, 2026.
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