F01.54
BillableVascular dementia, unspecified severity, with anxiety
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F01.54 an HCC code?
Yes. F01.54 maps to Dementia, Mild or Unspecified under the CMS-HCC V28 risk adjustment model.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for F01.54
For F01.54 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F01.54 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F01.54 is the ICD-10-CM diagnosis code for vascular dementia, unspecified severity, with anxiety. Dementia caused by reduced blood flow to the brain, with anxiety as a significant symptom. F01.54 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental disorders due to known physiological conditions (f01-f09).
Under the CMS-HCC V28 risk adjustment model, F01.54 maps to Dementia, Mild or Unspecified (HCC 127) with a community, non-dual, aged base RAF weight of 0.464. F01.54 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Anxiety in vascular dementia may present as worry, nervousness, or panic-like symptoms. Because F01.54 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F01.54 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Anxiety in vascular dementia may present as worry, nervousness, or panic-like symptoms
- •Confirm anxiety is present and document its severity and impact on the patient's functioning
Clinical Significance
Vascular dementia with anxiety captures clinically significant anxiety symptoms occurring in the context of cerebrovascular-caused cognitive decline. Anxiety in dementia patients often manifests as fear of being alone, generalized worry, or panic symptoms and can significantly worsen functional decline and quality of life.
Documentation Requirements
- ✓Diagnosis of vascular dementia with cerebrovascular etiology
- ✓Documented anxiety symptoms (generalized worry, fear, panic, separation anxiety)
- ✓Cognitive assessment results
- ✓Anxiety screening or assessment results if available
- ✓Treatment plan for anxiety (pharmacologic and non-pharmacologic approaches)
- ✓Distinction from behavioral, psychotic, and mood disturbances