HCC 136: Alcohol Use with Psychotic Complications ICD-10-CM
CMS-HCC Category 136 (Alcohol 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). 19 ICD-10-CM diagnosis codes map to HCC 136. A more severe related category (HCC 135) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.424 |
| Community, partial-benefit dual, aged | 0.522 |
| Community, full-benefit dual, aged | 0.502 |
| Community, non-dual, disabled | 0.637 |
| Community, partial-benefit dual, disabled | 0.922 |
| Community, full-benefit dual, disabled | 1.181 |
| Institutional | 0.297 |
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. In the hierarchy, HCC 135 (Drug Use with Psychotic Complications) supersedes HCC 136 when reported together. HCC 136 in turn supersedes 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 Codes That Map to HCC 136 19 codes
- F10.131 Alcohol abuse with withdrawal delirium from V24 HCC 54
- F10.132 Alcohol abuse with withdrawal with perceptual disturbance from V24 HCC 54
- F10.150 Alcohol abuse with alcohol-induced psychotic disorder with delusions from V24 HCC 54
- F10.151 Alcohol abuse with alcohol-induced psychotic disorder with hallucinations from V24 HCC 54
- F10.159 Alcohol abuse with alcohol-induced psychotic disorder, unspecified from V24 HCC 54
- F10.231 Alcohol dependence with withdrawal delirium from V24 HCC 54
- F10.232 Alcohol dependence with withdrawal with perceptual disturbance from V24 HCC 54
- F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions from V24 HCC 54
- F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations from V24 HCC 54
- F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified from V24 HCC 54
- F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder from V24 HCC 54
- F10.27 Alcohol dependence with alcohol-induced persisting dementia from V24 HCC 54
- F10.931 Alcohol use, unspecified with withdrawal delirium from V24 HCC 54
- F10.932 Alcohol use, unspecified with withdrawal with perceptual disturbance from V24 HCC 54
- F10.950 Alcohol use, unspecified with alcohol-induced psychotic disorder with delusions from V24 HCC 54
- F10.951 Alcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations from V24 HCC 54
- F10.959 Alcohol use, unspecified with alcohol-induced psychotic disorder, unspecified from V24 HCC 54
- F10.96 Alcohol use, unspecified with alcohol-induced persisting amnestic disorder from V24 HCC 54
- F10.97 Alcohol use, unspecified with alcohol-induced persisting dementia from V24 HCC 54
Every code above carries the full HCC 136 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 136
What is HCC 136 in the CMS-HCC model?
HCC 136 is CMS-HCC Category 136 (Alcohol Use with Psychotic Complications) in the V28 risk adjustment model. It covers 19 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 136?
For payment year 2026, HCC 136 adds 0.424 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.297 to 1.181 across the seven payment segments shown above.
Which categories supersede HCC 136?
HCC 135 (Drug Use with Psychotic Complications) sits above HCC 136 in the hierarchy: when a beneficiary has diagnoses in both, only the more severe category is paid.
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.
