Dementia, Moderate
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 126 carries a community non-dual aged RAF of 0.341, and 18 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 125 when a more severe category in the same disease group is also present.
Medically reviewed by Jess P., CPC · Reviewed: May 30, 2026
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.
Combine this factor with demographics and other HCCs in the RAF score calculator to model the full CMS-HCC V28 RAF for a member.
V28 hierarchy
Trumped by: HCC 125 (a more severe category in the same disease group supersedes this one).
Supersedes: HCC 127 (this category is counted instead of these when they co-occur).
ICD-10-CM codes that map to HCC 126 (18)
Payable diagnosis codes that map to this category under CMS-HCC V28 PY2026. Open any code for its full description, HCC mapping, and coding guidance.
- F01.B0Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
- F01.B11Vascular dementia, moderate, with agitation
- F01.B18Vascular dementia, moderate, with other behavioral disturbance
- F01.B2Vascular dementia, moderate, with psychotic disturbance
- F01.B3Vascular dementia, moderate, with mood disturbance
- F01.B4Vascular dementia, moderate, with anxiety
- F02.B0Dementia in other diseases classified elsewhere, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
- F02.B11Dementia in other diseases classified elsewhere, moderate, with agitation
- F02.B18Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance
- F02.B2Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance
- F02.B3Dementia in other diseases classified elsewhere, moderate, with mood disturbance
- F02.B4Dementia in other diseases classified elsewhere, moderate, with anxiety
- F03.B0Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
- F03.B11Unspecified dementia, moderate, with agitation
- F03.B18Unspecified dementia, moderate, with other behavioral disturbance
- F03.B2Unspecified dementia, moderate, with psychotic disturbance
- F03.B3Unspecified dementia, moderate, with mood disturbance
- F03.B4Unspecified dementia, moderate, with anxiety
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 126?
HCC 126 is "Dementia, Moderate", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 18 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 126?
The community non-dual aged relative factor for CMS-HCC V28 category 126 is 0.341. The exact factor varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 Rate Announcement.
How many ICD-10-CM codes map to HCC 126?
18 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 126 (Dementia, Moderate) for payment year 2026.
Which categories trump HCC 126 in the V28 hierarchy?
HCC 126 is superseded by HCC 125 (Dementia, Severe). When a more severe category in the same disease group is documented, it is counted instead of HCC 126.
Related references
Sources
CMS published ICD-10-CM mapping file plus 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.