What is ICD-10 code F03.92?

F03.92 is the ICD-10-CM diagnosis code for Unspecified dementia, unspecified severity, with psychotic disturbance. Dementia of unknown cause with psychotic symptoms such as delusions or hallucinations, where severity is not specified. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F03.92 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F03.92 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. F03.92 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. F03.92 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 F03.92 map to under V28?

F03.92 maps to CMS-HCC V28 127 (Dementia, Mild or Unspecified). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does F03.92 pay in RAF?

F03.92 carries a community, non-dual, aged (CNA) RAF weight of 0.341 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for F03.92?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F03.92, V28 maps to Dementia, Mild or Unspecified at RAF 0.341 while V24 mapped to Dementia With Complications at RAF 0.346. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM F03.92: Unspecified dementia

F03.92 maps to CMS-HCC V28 127 (RAF 0.341). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

ICD-10-CM Code View

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Code lookupF03.92Effective 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)

F03.92

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

Unspecified dementia, unspecified severity, with psychotic disturbance

Dementia of unknown cause with psychotic symptoms such as delusions or hallucinations, where severity is not specified.

Buddy Insight

CMS-HCC V28

Mapped

HCC 127

Dementia, Mild or Unspecified

RAF 0.341

CMS-HCC V24

Mapped

HCC 51

Dementia With Complications

RAF 0.346

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

Mapped

HCC 51

Dementia With Complications

RAF 0.042

RXHCC

Mapped

HCC 112

Dementia and Other Specified ...

Not separately weighted

Code Book Path

Official

F03Unspecified dementia

F03.9Unspecified dementia, unspecified severity

F03.92Unspecified dementia, unspecified severity, with psychotic disturbance

Inclusion Terms

Official

Unspecified dementia, unspecified severity, with psychotic disturbance such as hallucinations, paranoia, suspiciousness, or delusional state

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F03.92 in this effective period.

Related Child Codes

Official

F03.90Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety

F03.91Unspecified dementia, unspecified severity, with behavioral disturbance

F03.93Unspecified dementia, unspecified severity, with mood disturbance

F03.94Unspecified dementia, unspecified severity, with anxiety

Includes

Official

ICD-10-CM does not list Includes notes for F03.92 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F03.92 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F03.92 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F03.92 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F03.92 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must specify: (1) the dementia type and underlying etiology — F03 codes should only be used when the provider has not identified a specific etiology

query the provider to determine if a more specific dementia type can be documented to improve coding accuracy. (2) Severity must be clearly stated as unspecified 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

Documentation must specify: (1) the dementia type and underlying etiology — F03 codes should only be used when the provider has not identified a specific etiology

Audit Caution

HCC Buddy guidance

Defaulting to unspecified dementia (F03) when the provider has documented a specific etiology elsewhere in the record — always review the full chart for underlying causes such as Alzheimer disease, cerebrovascular disease, or Parkinson disease. Accepting unspecified severity without querying the provider — dementia severity directly affects HCC mapping and RAF weight. A simple query can yield a more specific code with higher risk adjustment value. 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. Misassigning dementia severity — the unspecified severity level maps to V28 HCC 127 with RAF 0.

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.

Common Mistakes

HCC Buddy guidance

F03.A0-F03.A4: Unspecified dementia, mild — use when severity is documented as mild

F03.B0-F03.B4: Unspecified dementia, moderate — use when severity is documented as moderate

F03.C0-F03.C4: Unspecified dementia, severe — use when severity is documented as severe

F01/F02 codes: Specified dementia types — always preferred when etiology is documented; query provider

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 F03.92 an HCC code?

Yes. F03.92 (Unspecified dementia, unspecified severity, with psychotic disturbance) maps to Dementia, Mild or Unspecified under the CMS-HCC V28 risk adjustment model (and Dementia With Complications under V24), with a community non-dual aged RAF of 0.341. It is billable for payment year 2026.

Coder answer: F03.92 is billable and maps to V28 HCC 127, Dementia, Mild or Unspecified. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F03.92
Description: Unspecified dementia, unspecified severity, with psychotic disturbance
HCC (V28): HCC 127 — Dementia, Mild or Unspecified
RAF: 0.341
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 127, Dementia, Mild or Unspecified

0.341

V24HCC 51, Dementia With Complications

0.346

ESRDHCC 51, Dementia With Complications

0.042

RxHCCHCC 112, Dementia and Other Specified Brain Disorders

Not separately weighted

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work F03.92 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for F03.92

For F03.92 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 F03.92 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F03.92 is the ICD-10-CM diagnosis code for unspecified dementia, unspecified severity, with psychotic disturbance. Dementia of unknown cause with psychotic symptoms such as delusions or hallucinations, where severity is not specified. F03.92 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, F03.92 maps to Dementia, Mild or Unspecified (HCC 127) with a community, non-dual, aged base RAF weight of 0.341. Under the older CMS-HCC V24 model, F03.92 maps to Dementia With Complications (HCC 51) with a community, non-dual, aged base RAF weight of 0.346. 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.

Clearly document psychotic symptoms in the clinical notes to justify this code selection. Because F03.92 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 F03.92 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Clearly document psychotic symptoms in the clinical notes to justify this code selection
•Consider whether the psychotic symptoms are primary or secondary to the dementia

Clinical Significance

Unspecified dementia, unspecified severity, with psychotic disturbance represents cognitive decline of unspecified severity with psychotic features such as hallucinations or delusions, where the underlying cause has not been determined. This diagnosis carries important implications for patient safety, functional status, and caregiver burden. Providers should be queried for a more specific etiology whenever possible, as unspecified dementia may indicate incomplete workup rather than truly idiopathic disease.

Documentation Requirements

✓Documentation must specify: (1) the dementia type and underlying etiology — F03 codes should only be used when the provider has not identified a specific etiology
✓query the provider to determine if a more specific dementia type can be documented to improve coding accuracy. (2) Severity must be clearly stated as unspecified 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.

Commonly Confused Codes

•F03.A0-F03.A4: Unspecified dementia, mild: use when severity is documented as mild
•F03.B0-F03.B4: Unspecified dementia, moderate: use when severity is documented as moderate
•F03.C0-F03.C4: Unspecified dementia, severe: use when severity is documented as severe
•F01/F02 codes: Specified dementia types: always preferred when etiology is documented; query provider
•R41.81: Age-related cognitive decline: not a dementia diagnosis; ensure dementia criteria are met