Drug Use with Psychotic Complications

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 136, HCC 137, HCC 138, HCC 139 (this category is counted instead of these when they co-occur).

Frequently asked questions

Related references

• CMS-HCC V28 modelAll 115 V28 categories, source-labeled coefficient references, and hierarchy.
• ICD-10 to HCC mappingHow an ICD-10-CM code resolves to a payment HCC under V28.
• MEAT criteriaThe documentation standard every coded condition must satisfy.

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.