CMS-HCC Risk Adjustment · V28 Model · Payment Year 2026 97 Codes

HCC 135: Drug Use with Psychotic Complications ICD-10-CM

CMS-HCC Category 135 (Drug Use with Psychotic Complications) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.297 and 1.181 to a beneficiary's RAF score depending on the payment segment (0.424 for a community, non-dual, aged enrollee). 97 ICD-10-CM diagnosis codes map to HCC 135. It sits at the top of its hierarchy: no other condition category supersedes it.

✓ Built from the official CMS PY 2026 risk adjustment filesV28 pays 100% of MA risk scores from PY 2026
+0.424
RAF, Community Non-Dual Aged
97
ICD-10-CM Codes
Top
Of Its Hierarchy
PY 2026
Dataset
CMS-HCC V28

RAF Weight by Payment Segment 7 segments

Payment SegmentRelative Factor
Community, non-dual, aged0.424
Community, partial-benefit dual, aged0.522
Community, full-benefit dual, aged0.702
Community, non-dual, disabled0.637
Community, partial-benefit dual, disabled0.922
Community, full-benefit dual, disabled1.181
Institutional0.297

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 135 in turn supersedes HCC 136 (Alcohol Use with Psychotic Complications), HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications), HCC 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis), and HCC 139 (Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications).

ICD-10-CM

ICD-10-CM Codes That Map to HCC 135 97 codes

97 of 97 shown
  • F11.150 Opioid abuse with opioid-induced psychotic disorder with delusions from V24 HCC 54
  • F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations from V24 HCC 54
  • F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified from V24 HCC 54
  • F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions from V24 HCC 54
  • F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations from V24 HCC 54
  • F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified from V24 HCC 54
  • F11.950 Opioid use, unspecified with opioid-induced psychotic disorder with delusions from V24 HCC 54
  • F11.951 Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations from V24 HCC 54
  • F11.959 Opioid use, unspecified with opioid-induced psychotic disorder, unspecified from V24 HCC 54
  • F12.150 Cannabis abuse with psychotic disorder with delusions from V24 HCC 54
  • F12.151 Cannabis abuse with psychotic disorder with hallucinations from V24 HCC 54
  • F12.159 Cannabis abuse with psychotic disorder, unspecified from V24 HCC 54
  • F12.250 Cannabis dependence with psychotic disorder with delusions from V24 HCC 54
  • F12.251 Cannabis dependence with psychotic disorder with hallucinations from V24 HCC 54
  • F12.259 Cannabis dependence with psychotic disorder, unspecified from V24 HCC 54
  • F12.950 Cannabis use, unspecified with psychotic disorder with delusions from V24 HCC 54
  • F12.951 Cannabis use, unspecified with psychotic disorder with hallucinations from V24 HCC 54
  • F12.959 Cannabis use, unspecified with psychotic disorder, unspecified from V24 HCC 54
  • F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium from V24 HCC 54
  • F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance from V24 HCC 54
  • F13.150 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions from V24 HCC 54
  • F13.151 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations from V24 HCC 54
  • F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified from V24 HCC 54
  • F13.231 Sedative, hypnotic or anxiolytic dependence with withdrawal delirium from V24 HCC 54
  • F13.232 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance from V24 HCC 54
  • F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions from V24 HCC 54
  • F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations from V24 HCC 54
  • F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified from V24 HCC 54
  • F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder from V24 HCC 54
  • F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia from V24 HCC 54
  • F13.931 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal delirium from V24 HCC 54
  • F13.932 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal with perceptual disturbances from V24 HCC 54
  • F13.950 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions from V24 HCC 54
  • F13.951 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations from V24 HCC 54
  • F13.959 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified from V24 HCC 54
  • F13.96 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder from V24 HCC 54
  • F13.97 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia from V24 HCC 54
  • F14.150 Cocaine abuse with cocaine-induced psychotic disorder with delusions from V24 HCC 54
  • F14.151 Cocaine abuse with cocaine-induced psychotic disorder with hallucinations from V24 HCC 54
  • F14.159 Cocaine abuse with cocaine-induced psychotic disorder, unspecified from V24 HCC 54
  • F14.250 Cocaine dependence with cocaine-induced psychotic disorder with delusions from V24 HCC 54
  • F14.251 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations from V24 HCC 54
  • F14.259 Cocaine dependence with cocaine-induced psychotic disorder, unspecified from V24 HCC 54
  • F14.950 Cocaine use, unspecified with cocaine-induced psychotic disorder with delusions from V24 HCC 54
  • F14.951 Cocaine use, unspecified with cocaine-induced psychotic disorder with hallucinations from V24 HCC 54
  • F14.959 Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified from V24 HCC 54
  • F15.150 Other stimulant abuse with stimulant-induced psychotic disorder with delusions from V24 HCC 54
  • F15.151 Other stimulant abuse with stimulant-induced psychotic disorder with hallucinations from V24 HCC 54
  • F15.159 Other stimulant abuse with stimulant-induced psychotic disorder, unspecified from V24 HCC 54
  • F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions from V24 HCC 54
  • F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations from V24 HCC 54
  • F15.259 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified from V24 HCC 54
  • F15.950 Other stimulant use, unspecified with stimulant-induced psychotic disorder with delusions from V24 HCC 54
  • F15.951 Other stimulant use, unspecified with stimulant-induced psychotic disorder with hallucinations from V24 HCC 54
  • F15.959 Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified from V24 HCC 54
  • F16.150 Hallucinogen abuse with hallucinogen-induced psychotic disorder with delusions from V24 HCC 54
  • F16.151 Hallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations from V24 HCC 54
  • F16.159 Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified from V24 HCC 54
  • F16.250 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions from V24 HCC 54
  • F16.251 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations from V24 HCC 54
  • F16.259 Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified from V24 HCC 54
  • F16.950 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions from V24 HCC 54
  • F16.951 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with hallucinations from V24 HCC 54
  • F16.959 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified from V24 HCC 54
  • F18.150 Inhalant abuse with inhalant-induced psychotic disorder with delusions from V24 HCC 54
  • F18.151 Inhalant abuse with inhalant-induced psychotic disorder with hallucinations from V24 HCC 54
  • F18.159 Inhalant abuse with inhalant-induced psychotic disorder, unspecified from V24 HCC 54
  • F18.17 Inhalant abuse with inhalant-induced dementia from V24 HCC 54
  • F18.250 Inhalant dependence with inhalant-induced psychotic disorder with delusions from V24 HCC 54
  • F18.251 Inhalant dependence with inhalant-induced psychotic disorder with hallucinations from V24 HCC 54
  • F18.259 Inhalant dependence with inhalant-induced psychotic disorder, unspecified from V24 HCC 54
  • F18.27 Inhalant dependence with inhalant-induced dementia from V24 HCC 54
  • F18.950 Inhalant use, unspecified with inhalant-induced psychotic disorder with delusions from V24 HCC 54
  • F18.951 Inhalant use, unspecified with inhalant-induced psychotic disorder with hallucinations from V24 HCC 54
  • F18.959 Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified from V24 HCC 54
  • F18.97 Inhalant use, unspecified with inhalant-induced persisting dementia from V24 HCC 54
  • F19.131 Other psychoactive substance abuse with withdrawal delirium from V24 HCC 54
  • F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance from V24 HCC 54
  • F19.150 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions from V24 HCC 54
  • F19.151 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations from V24 HCC 54
  • F19.159 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified from V24 HCC 54
  • F19.16 Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder from V24 HCC 54
  • F19.17 Other psychoactive substance abuse with psychoactive substance-induced persisting dementia from V24 HCC 54
  • F19.231 Other psychoactive substance dependence with withdrawal delirium from V24 HCC 54
  • F19.232 Other psychoactive substance dependence with withdrawal with perceptual disturbance from V24 HCC 54
  • F19.250 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions from V24 HCC 54
  • F19.251 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations from V24 HCC 54
  • F19.259 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified from V24 HCC 54
  • F19.26 Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder from V24 HCC 54
  • F19.27 Other psychoactive substance dependence with psychoactive substance-induced persisting dementia from V24 HCC 54
  • F19.931 Other psychoactive substance use, unspecified with withdrawal delirium from V24 HCC 54
  • F19.932 Other psychoactive substance use, unspecified with withdrawal with perceptual disturbance from V24 HCC 54
  • F19.950 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions from V24 HCC 54
  • F19.951 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations from V24 HCC 54
  • F19.959 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified from V24 HCC 54
  • F19.96 Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder from V24 HCC 54
  • F19.97 Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia from V24 HCC 54

Every code above carries the full HCC 135 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 135

What is HCC 135 in the CMS-HCC model?

HCC 135 is CMS-HCC Category 135 (Drug Use with Psychotic Complications) in the V28 risk adjustment model. It covers 97 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.

What is the RAF weight for HCC 135?

For payment year 2026, HCC 135 adds 0.424 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 0.297 to 1.181 across the seven payment segments shown above.

Related References

All HCC CategoriesHCC 136 CodesHCC 137 CodesHCC 138 CodesHCC 139 CodesV24 to V28: What ChangedICD-10-CM Code Lookup

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.