What is ICD-10 code F02.B2?

F02.B2 is the ICD-10-CM diagnosis code for Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance. Moderate-stage dementia caused by another disease with hallucinations, delusions, or other psychotic features. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F02.B2 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F02.B2 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F02.B2 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F02.B2 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does F02.B2 map to under V28?

F02.B2 maps to CMS-HCC V28 HCC 126 (Dementia, Moderate). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM F02.B2: Dementia in other diseases

F02.B2 maps to CMS-HCC V28 126. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupF02.B2Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental disorders due to known physiological conditions (F01-F09)

F02.B2

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance

Moderate-stage dementia caused by another disease with hallucinations, delusions, or other psychotic features.

Buddy Insight

CMS-HCC V28

Mapped

HCC 126

Dementia, Moderate

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

Mapped

HCC 51

Dementia With Complications

Code-level coefficient reference

RXHCC

Mapped

HCC 112

Dementia, Except Alzheimer's ...

Code-level coefficient reference

Code Book Path

Official

F02Dementia in other diseases classified elsewhere

F02.BDementia in other diseases classified elsewhere, moderate

F02.B2Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance

Inclusion Terms

Official

Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance such as hallucinations, paranoia, suspiciousness, or delusional state
Major neurocognitive disorder in other diseases classified elsewhere, moderate, with psychotic disturbance such as hallucinations, paranoia, suspiciousness, or delusional state

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F02.B2 in this effective period.

Related Child Codes

Official

F02.B0Dementia in other diseases classified elsewhere, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety

F02.B1Dementia in other diseases classified elsewhere, moderate, with behavioral disturbance

F02.B3Dementia in other diseases classified elsewhere, moderate, with mood disturbance

F02.B4Dementia in other diseases classified elsewhere, moderate, with anxiety

Includes

Official

ICD-10-CM does not list Includes notes for F02.B2 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F02.B2 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F02.B2 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F02.B2 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F02.B2 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must specify: (1) the dementia type and underlying etiology — F02 codes require a code-first relationship — the underlying condition (e.g., Parkinson disease, Huntington disease, HIV, traumatic brain injury) must be sequenced before the F02 code.

(2) Severity must be clearly stated as moderate based on standardized assessment tools such as the Clinical Dementia Rating (CDR) scale or Mini-Mental State Examination (MMSE).

(3) Document the type of psychotic features present — visual hallucinations, auditory hallucinations, paranoid delusions, or misidentification syndromes — and confirm they are attributable to the dementia rather than a primary psychiatric disorder.

(4) Document the impact on activities of daily living, need for supervision, and current medication management.

MEAT Support

HCC Buddy guidance

(2) Severity must be clearly stated as moderate based on standardized assessment tools such as the Clinical Dementia Rating (CDR) scale or Mini-Mental State Examination (MMSE).

(4) Document the impact on activities of daily living, need for supervision, and current medication management.

Audit Caution

HCC Buddy guidance

Omitting the code-first underlying condition — F02 codes mandate that the causative disease (e.g., G30 for Alzheimer, G20 for Parkinson, B20 for HIV) is sequenced before the dementia code. Separately coding a psychotic disorder (e.g., F06.2) when the psychotic symptoms are a direct manifestation of the dementia — the combination code captures both.

Incorrect staging can result in either over- or under-reporting risk, affecting both compliance and reimbursement accuracy. Overlooking the ICD-10-CM guideline requiring that dementia behavioral codes be used as combination codes — do not assign both a dementia code and a separate code for the behavioral/psychiatric manifestation when the combination code exists.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is F02.B2 an HCC code?

Yes. F02.B2 (Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance) maps to HCC 126, Dementia, Moderate under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.341. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: F02.B2 is billable and maps to V28 HCC 126, Dementia, Moderate. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F02.B2
Description: Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance
HCC (V28): HCC 126 — Dementia, Moderate
RAF reference coefficient: 0.341
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 126, Dementia, Moderate

0.341

ESRDHCC 51, Dementia With Complications

Not separately weighted

RxHCCHCC 112, Dementia, Except Alzheimer's Disease

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work F02.B2 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for F02.B2

For F02.B2 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 F02.B2 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F02.B2 is the ICD-10-CM diagnosis code for dementia in other diseases classified elsewhere, moderate, with psychotic disturbance. Moderate-stage dementia caused by another disease with hallucinations, delusions, or other psychotic features. F02.B2 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, F02.B2 maps to Dementia, Moderate (HCC 126) with a source-labeled community, non-dual, aged reference coefficient of 0.341. No V24 mapping is shown for F02.B2; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Document the content and type of psychotic symptoms (visual vs. auditory hallucinations, paranoid delusions, etc.). Because F02.B2 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for F02.B2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the content and type of psychotic symptoms (visual vs. auditory hallucinations, paranoid delusions, etc.)
•Confirm psychotic symptoms are secondary to dementia and not a primary psychotic disorder

Clinical Significance

Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance represents cognitive deterioration secondary to an underlying medical condition, at the moderate stage with psychotic features such as hallucinations or delusions. This code captures the dementia manifestation of systemic or neurological diseases such as Parkinson disease, Lewy body disease, Huntington disease, HIV, or prion disease. Proper identification of both the underlying etiology and the dementia severity with associated symptoms is critical for treatment planning and risk stratification.

Documentation Requirements

✓Documentation must specify: (1) the dementia type and underlying etiology — F02 codes require a code-first relationship — the underlying condition (e.g., Parkinson disease, Huntington disease, HIV, traumatic brain injury) must be sequenced before the F02 code.
✓(2) Severity must be clearly stated as moderate based on standardized assessment tools such as the Clinical Dementia Rating (CDR) scale or Mini-Mental State Examination (MMSE).
✓(3) Document the type of psychotic features present — visual hallucinations, auditory hallucinations, paranoid delusions, or misidentification syndromes — and confirm they are attributable to the dementia rather than a primary psychiatric disorder.
✓(4) Document the impact on activities of daily living, need for supervision, and current medication management.