V28 HCC 125
Dementia, Severe
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 125 has a source-labeled community non-dual aged reference coefficient of 0.341, and 18 ICD-10-CM diagnosis codes appear in its official mapping.
RAF factors
The community factor varies by Medicaid and originally-disabled status; the institutional factor applies to long-term-institutional members. These are the CMS-HCC V28 PY2026 relative factors.
These are source-labeled code-level HCC coefficient references, not a full member score. Use the RAF Calculator with complete member context for CMS-HCC V28 PY2026. No score is shown unless every required source and calculation check passes.
V28 hierarchy
Supersedes: HCC 126, HCC 127 (this category is counted instead of these when they co-occur).
ICD-10-CM codes that map to HCC 125 (18)
ICD-10-CM codes in the official mapping for this category under CMS-HCC V28 PY2026. Open any code for its full description and coding guidance.
- F01.C0Vascular dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
- F01.C11Vascular dementia, severe, with agitation
- F01.C18Vascular dementia, severe, with other behavioral disturbance
- F01.C2Vascular dementia, severe, with psychotic disturbance
- F01.C3Vascular dementia, severe, with mood disturbance
- F01.C4Vascular dementia, severe, with anxiety
- F02.C0Dementia in other diseases classified elsewhere, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
- F02.C11Dementia in other diseases classified elsewhere, severe, with agitation
- F02.C18Dementia in other diseases classified elsewhere, severe, with other behavioral disturbance
- F02.C2Dementia in other diseases classified elsewhere, severe, with psychotic disturbance
- F02.C3Dementia in other diseases classified elsewhere, severe, with mood disturbance
- F02.C4Dementia in other diseases classified elsewhere, severe, with anxiety
- F03.C0Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
- F03.C11Unspecified dementia, severe, with agitation
- F03.C18Unspecified dementia, severe, with other behavioral disturbance
- F03.C2Unspecified dementia, severe, with psychotic disturbance
- F03.C3Unspecified dementia, severe, with mood disturbance
- F03.C4Unspecified dementia, severe, with anxiety
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 125?
HCC 125 is "Dementia, Severe", a Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 18 ICD-10-CM codes appear in its official mapping.
What reference coefficient is published for HCC 125?
The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 125 is 0.341. The exact coefficient varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 model files.
How many ICD-10-CM codes map to HCC 125?
18 ICD-10-CM diagnosis codes appear in the official mapping for CMS-HCC V28 category 125 (Dementia, Severe) for payment year 2026.
Related references
Sources
CMS ICD-10-CM order-file billability plus the published mapping and CMS-HCC V28 PY2026 model software. CMS-HCC V28 model published at CMS.gov Risk Adjustors; ICD-10-CM member codes from the CMS ICD-10-CM code set.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 30, 2026.