F01.B0
BillableVascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F01.B0 an HCC code?
Yes. F01.B0 maps to Dementia, Moderate 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.B0
For F01.B0 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.B0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F01.B0 is the ICD-10-CM diagnosis code for vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Mid-stage dementia caused by reduced blood flow to the brain, without behavioral, mood, anxiety, or psychotic symptoms. F01.B0 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.B0 maps to Dementia, Moderate (HCC 126) with a community, non-dual, aged base RAF weight of 0.550. F01.B0 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.
Use this code for moderate vascular dementia when cognitive decline is more significant but psychiatric symptoms are absent. Because F01.B0 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.B0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for moderate vascular dementia when cognitive decline is more significant but psychiatric symptoms are absent
- •Verify that the severity level is documented as moderate in the clinical record
Clinical Significance
Moderate vascular dementia without behavioral disturbance represents intermediate-stage cerebrovascular cognitive decline where the patient requires assistance with instrumental and some basic activities of daily living. The moderate stage often necessitates caregiver involvement and begins the transition toward more intensive support needs.
Documentation Requirements
- ✓Diagnosis of vascular dementia with cerebrovascular etiology
- ✓Severity explicitly documented as 'moderate' by the treating provider
- ✓Cognitive testing supporting moderate impairment
- ✓Functional assessment documenting need for assistance with activities of daily living
- ✓Confirmation of absence of behavioral, psychotic, mood, and anxiety disturbances
- ✓Brain imaging consistent with vascular etiology
- ✓Care coordination and caregiver support plan
Commonly Confused Codes
- •F01.A0 — Vascular dementia, mild: earlier stage with greater preserved function
- •F01.50 — Vascular dementia, unspecified severity: use only when severity is not specified
- •F01.C0 — Vascular dementia, severe: later stage with more profound impairment
- •F01.B11 — Vascular dementia, moderate, with agitation: use when behavioral disturbance is present