V28 HCC 137Community non-dual aged RAF 0.424

Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 137 carries a community non-dual aged RAF of 0.424, and 308 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 135, HCC 136 when a more severe category in the same disease group is also present.

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: 0.394Community FBA: 0.502Community ND: 0.365Community PBD: 0.348Community FBD: 0.471Institutional: 0.297

V28 hierarchy

Trumped by: HCC 135, HCC 136 (a more severe category in the same disease group supersedes this one).

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

ICD-10-CM codes that map to HCC 137 (308)

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.

Frequently asked questions

What is CMS-HCC V28 category 137?

HCC 137 is "Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 308 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 137?

The community non-dual aged relative factor for CMS-HCC V28 category 137 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 137?

308 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) for payment year 2026.

Which categories trump HCC 137 in the V28 hierarchy?

HCC 137 is superseded by HCC 135 (Drug Use with Psychotic Complications), HCC 136 (Alcohol Use with Psychotic Complications). When a more severe category in the same disease group is documented, it is counted instead of HCC 137.

Source: CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software.