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V28 HCC 135Community non-dual aged RAF 0.424

Drug Use with Psychotic Complications

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 135 carries a community non-dual aged RAF of 0.424, and 97 payable ICD-10-CM diagnosis codes map to it.

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.

Community NA: 0.424Community PBA: 0.522Community FBA: 0.702Community ND: 0.637Community PBD: 0.922Community FBD: 1.181Institutional: 0.297

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

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

ICD-10-CM codes that map to HCC 135 (97)

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.

Coder workflow notes

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A printable one-pager for HCC 135: which member codes risk-adjust, the RAF weight, and the MEAT your notes need to make it stick. Free, no card.

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Frequently asked questions

What is CMS-HCC V28 category 135?

HCC 135 is "Drug Use with Psychotic Complications", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 97 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 135?

The community non-dual aged relative factor for CMS-HCC V28 category 135 is 0.424. 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 135?

97 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 135 (Drug Use with Psychotic Complications) for payment year 2026.

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.