HCC 125: Dementia, Severe ICD-10-CM
CMS-HCC Category 125 (Dementia, Severe) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.000 and 0.438 to a beneficiary's RAF score depending on the payment segment (0.341 for a community, non-dual, aged enrollee). 18 ICD-10-CM diagnosis codes map to HCC 125. It sits at the top of its hierarchy: no other condition category supersedes it.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.341 |
| Community, partial-benefit dual, aged | 0.401 |
| Community, full-benefit dual, aged | 0.438 |
| Community, non-dual, disabled | 0.296 |
| Community, partial-benefit dual, disabled | 0.345 |
| Community, full-benefit dual, disabled | 0.367 |
| Institutional | 0.000 |
A beneficiary is scored in exactly one segment, set by Medicaid (dual) status, aged or disabled entitlement, and residence. Factors are relative weights, not dollar amounts; new-enrollee segments score on demographics only. HCC 125 in turn supersedes HCC 126 (Dementia, Moderate) and HCC 127 (Dementia, Mild or Unspecified).
ICD-10-CM Codes That Map to HCC 125 18 codes
- F01.C0 Vascular dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety from V24 HCC 52
- F01.C11 Vascular dementia, severe, with agitation from V24 HCC 51
- F01.C18 Vascular dementia, severe, with other behavioral disturbance from V24 HCC 51
- F01.C2 Vascular dementia, severe, with psychotic disturbance from V24 HCC 51
- F01.C3 Vascular dementia, severe, with mood disturbance from V24 HCC 51
- F01.C4 Vascular dementia, severe, with anxiety from V24 HCC 51
- F02.C0 Dementia in other diseases classified elsewhere, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety from V24 HCC 52
- F02.C11 Dementia in other diseases classified elsewhere, severe, with agitation from V24 HCC 51
- F02.C18 Dementia in other diseases classified elsewhere, severe, with other behavioral disturbance from V24 HCC 51
- F02.C2 Dementia in other diseases classified elsewhere, severe, with psychotic disturbance from V24 HCC 51
- F02.C3 Dementia in other diseases classified elsewhere, severe, with mood disturbance from V24 HCC 51
- F02.C4 Dementia in other diseases classified elsewhere, severe, with anxiety from V24 HCC 51
- F03.C0 Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety from V24 HCC 52
- F03.C11 Unspecified dementia, severe, with agitation from V24 HCC 51
- F03.C18 Unspecified dementia, severe, with other behavioral disturbance from V24 HCC 51
- F03.C2 Unspecified dementia, severe, with psychotic disturbance from V24 HCC 51
- F03.C3 Unspecified dementia, severe, with mood disturbance from V24 HCC 51
- F03.C4 Unspecified dementia, severe, with anxiety from V24 HCC 51
Every code above carries the full HCC 125 weight when documented and reported on a Medicare Advantage encounter. The code link opens its full page with the complete risk adjustment card.
Questions About HCC 125
What is HCC 125 in the CMS-HCC model?
HCC 125 is CMS-HCC Category 125 (Dementia, Severe) in the V28 risk adjustment model. It covers 18 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 125?
For payment year 2026, HCC 125 adds 0.341 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.000 to 0.438 across the seven payment segments shown above.
Related References
Source: Centers for Medicare & Medicaid Services, Payment Year 2026 risk adjustment mapping and model software releases (CMS-HCC V28), applied to the FY 2026 ICD-10-CM code set. ICD List is not affiliated with CMS.
