F01.B11
BillableVascular dementia, moderate, with agitation
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F01.B11 an HCC code?
Yes. F01.B11 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.B11
For F01.B11 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.B11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F01.B11 is the ICD-10-CM diagnosis code for vascular dementia, moderate, with agitation. Mid-stage dementia caused by reduced blood flow to the brain with agitation or restlessness. F01.B11 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.B11 maps to Dementia, Moderate (HCC 126) with a community, non-dual, aged base RAF weight of 0.550. F01.B11 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.
Agitation is a specific behavioral disturbance; document observable signs such as pacing, verbal outbursts, or physical aggression. Because F01.B11 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.B11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Agitation is a specific behavioral disturbance; document observable signs such as pacing, verbal outbursts, or physical aggression
- •This code is more specific than F01.B18 and should be used when agitation is the primary behavioral concern
Clinical Significance
Moderate vascular dementia with agitation represents intermediate-stage cerebrovascular cognitive decline complicated by agitated behavior. Agitation at the moderate stage often requires pharmacologic intervention and increases the risk of institutionalization, falls, and caregiver burnout.
Documentation Requirements
- ✓Diagnosis of vascular dementia with cerebrovascular etiology
- ✓Severity explicitly documented as 'moderate'
- ✓Documented agitation (physical restlessness, verbal aggression, combative behavior)
- ✓Cognitive testing supporting moderate impairment
- ✓Functional assessment documenting assistance needs
- ✓Behavioral management plan including non-pharmacologic and pharmacologic interventions
- ✓Safety assessment for patient and caregivers