F03.C2 maps to CMS-HCC V28 125. 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.C2

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.C2

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

Unspecified dementia, severe, with psychotic disturbance

Severe dementia where the person experiences psychotic symptoms such as hallucinations or delusions in addition to their cognitive decline.

Buddy Insight

This code captures severe unspecified dementia with psychotic disturbance, representing significant cognitive impairment that affects the patient's functional status and care needs.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 125

Dementia, Severe

Coefficient HCC 125: 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 51

ESRD candidates: HCC 51 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.CUnspecified dementia, severe F03.C2Unspecified dementia, severe, with psychotic disturbance

Inclusion Terms

Official

Unspecified dementia, severe, with psychotic disturbance such as hallucinations, paranoia, suspiciousness, or delusional state
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.C0Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety F03.C1Unspecified dementia, severe, with behavioral disturbance F03.C3Unspecified dementia, severe, with mood disturbance F03.C4Unspecified dementia, severe, 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.C2. 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.C2. 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.C2. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F03.C2. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation explicitly stating dementia severity as 'severe'

Cognitive assessment results (e.g., MMSE, MoCA, or SLUMS score) supporting the stated severity level

Functional status assessment documenting impact on activities of daily living

Statement that underlying etiology is unknown or unspecified (if a known cause exists, use a more specific dementia code)

MEAT Support

HCC Buddy guidance

Provider documentation explicitly stating dementia severity as 'severe'

Cognitive assessment results (e.g., MMSE, MoCA, or SLUMS score) supporting the stated severity level

Functional status assessment documenting impact on activities of daily living

Statement that underlying etiology is unknown or unspecified (if a known cause exists, use a more specific dementia code)

Audit Caution

HCC Buddy guidance

Coding severe dementia without cognitive assessment documentation to support the severity level

Using 'unspecified' dementia codes when the provider has documented a specific etiology (Alzheimer, vascular, Lewy body, etc.)

Failing to code behavioral/psychiatric manifestations that are documented — always check for the most specific 6th character

Defaulting to severe when documentation only states 'advanced' or 'end-stage' without formal cognitive staging — clarify with provider

Common Mistakes

HCC Buddy guidance

F03.B0 — Unspecified dementia, moderate, without behavioral disturbance; lower severity level

F01.C0 through F01.C4 — Vascular dementia, severe; use when documentation attributes dementia to cerebrovascular disease

F02.C0 through F02.C4 — Dementia in other diseases classified elsewhere, severe; use when a known underlying condition causes the dementia (code underlying condition first)

G30.9 with F02 codes — Alzheimer disease with dementia; use F02 codes when Alzheimer is the documented cause

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.C2 an HCC code?

Yes. F03.C2 (Unspecified dementia, severe, with psychotic disturbance) maps to HCC 125, Dementia, Severe 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.C2 is billable and maps to V28 HCC 125, Dementia, Severe. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F03.C2
Description: Unspecified dementia, severe, with psychotic disturbance
HCC (V28): HCC 125 — Dementia, Severe
RAF reference coefficient: 0.341
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 125, Dementia, Severe

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.C2 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F03.C2

For F03.C2, 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

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

F03.C2 is the ICD-10-CM diagnosis code for unspecified dementia, severe, with psychotic disturbance. Severe dementia where the person experiences psychotic symptoms such as hallucinations or delusions in addition to their cognitive decline. F03.C2 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.C2 maps to Dementia, Severe (HCC 125) 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.

Ensure psychotic symptoms (hallucinations or delusions) are clearly documented. For F03.C2, 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.C2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Ensure psychotic symptoms (hallucinations or delusions) are clearly documented
•Distinguish from other behavioral disturbances; psychotic disturbance is specifically about hallucinations or delusions

Clinical Significance

This code captures severe unspecified dementia with psychotic disturbance, representing significant cognitive impairment that affects the patient's functional status and care needs. Severe dementia carries substantial risk adjustment weight because these patients require intensive care coordination, caregiver support, and monitoring for complications. Accurate severity staging and behavioral documentation directly impact both clinical management and appropriate resource allocation.

Documentation Requirements

✓Provider documentation explicitly stating dementia severity as 'severe'
✓Cognitive assessment results (e.g., MMSE, MoCA, or SLUMS score) supporting the stated severity level
✓Functional status assessment documenting impact on activities of daily living
✓Statement that underlying etiology is unknown or unspecified (if a known cause exists, use a more specific dementia code)
✓Documentation of psychotic symptoms (delusions, hallucinations) as a manifestation of the dementia, not a primary psychotic disorder

Commonly Confused Codes

•F03.B0: Unspecified dementia, moderate, without behavioral disturbance; lower severity level
•F01.C0 through F01.C4: Vascular dementia, severe; use when documentation attributes dementia to cerebrovascular disease
•F02.C0 through F02.C4: Dementia in other diseases classified elsewhere, severe; use when a known underlying condition causes the dementia (code underlying condition first)
•G30.9 with F02 codes: Alzheimer disease with dementia; use F02 codes when Alzheimer is the documented cause