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V28 HCC 137

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 has a source-labeled community non-dual aged reference coefficient of 0.424, and 308 ICD-10-CM diagnosis codes appear in its official mapping. In the V28 hierarchy it is superseded by HCC 135, HCC 136 when a more severe category in the same disease group is also present.

By the HCC Buddy Coding Team · Reviewed: May 30, 2026
V28 HCC 137Community non-dual aged reference coefficient 0.424
See ICD-10-CM codes for HCC 137Open the RAF Calculator

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

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

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)

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.

Coder workflow notes

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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 Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 308 ICD-10-CM codes appear in its official mapping.

What reference coefficient is published for HCC 137?

The source-labeled community non-dual aged reference coefficient for CMS-HCC V28 category 137 is 0.424. 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 137?

308 ICD-10-CM diagnosis codes appear in the official mapping for 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.

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.