F03.B0 maps to CMS-HCC V28 126. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF03.B0

Effective 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.B0

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

Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety

Mid-stage dementia of unknown type without any accompanying behavioral, psychotic, mood, or anxiety symptoms.

Buddy Insight

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 126

Dementia, Moderate

Coefficient HCC 126: 0.341 (Community Non-Dual Aged (CNA))

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

Context needed

HCC 52

ESRD candidates: HCC 52 when age >= 15. ESRD mapping is separate from PACE. Dialysis, graft, age, and other member context determine the applicable coefficient.

Coefficient needs member context

RXHCC

Context needed

HCC 112

RxHCC candidates: HCC 112 when age >= 15. RxHCC mapping is current. Member segment is still required before using a coefficient.

Coefficient needs member context

Code Book Path

Official

F03Unspecified dementia F03.BUnspecified dementia, moderate F03.B0Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety

Inclusion Terms

Official

Dementia, moderate, NOS
Major neurocognitive disorder NOSInherited from F03
Presenile dementia NOSInherited from F03
Presenile psychosis NOSInherited from F03
Primary degenerative dementia NOSInherited from F03
Senile dementia NOSInherited from F03
Senile dementia depressed or paranoid typeInherited from F03
Senile psychosis NOSInherited from F03

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99, F03
dementia with delirium or acute confusional state (F05)Inherited from F01-F99, F03
mild memory disturbance due to known physiological condition (F06.8)Inherited from F01-F99, F03

Related Codes

Official

F03.B1Unspecified dementia, moderate, with behavioral disturbance F03.B2Unspecified dementia, moderate, with psychotic disturbance F03.B3Unspecified dementia, moderate, with mood disturbance F03.B4Unspecified dementia, moderate, with anxiety

Includes

Official

disorders of psychological developmentInherited from F01-F99

Excludes 1

Official

No Excludes 1 notes are included in this display for F03.B0. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for F03.B0. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F03.B0. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F03.B0. Check the code and parent instructions in the Code Book.

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 moderate based on standardized assessment tools such as the Clinical Dementia Rating (CDR) scale or Mini-Mental State Examination (MMSE). (3) Document the absence of behavioral and psychiatric symptoms explicitly. (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. Using the 'without behavioral disturbance' code when behavioral symptoms are present but undocumented — review nursing notes and caregiver reports for evidence of behavioral, psychotic, mood, or anxiety symptoms.

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 F03.B0 an HCC code?

Yes. F03.B0 (Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety) 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: F03.B0 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: F03.B0
Description: Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
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

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 F03.B0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F03.B0

For F03.B0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

F03.B0 is the ICD-10-CM diagnosis code for unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Mid-stage dementia of unknown type without any accompanying behavioral, psychotic, mood, or anxiety symptoms. F03.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, F03.B0 maps to Dementia, Moderate (HCC 126) with a source-labeled community, non-dual, aged reference coefficient of 0.341. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.

This code indicates moderate severity with no behavioral or psychiatric complications documented. For F03.B0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 F03.B0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code indicates moderate severity with no behavioral or psychiatric complications documented
•Use only when clinical documentation explicitly states absence of behavioral and psychiatric disturbances

Clinical Significance

Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety represents cognitive decline of moderate severity with no associated behavioral, psychotic, mood, or anxiety disturbance, 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 moderate based on standardized assessment tools such as the Clinical Dementia Rating (CDR) scale or Mini-Mental State Examination (MMSE). (3) Document the absence of behavioral and psychiatric symptoms explicitly. (4) Document the impact on activities of daily living, need for supervision, and current medication management.