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 (living at home, age 65 or over, not also enrolled in Medicaid). 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.
