HCC 138: Drug Use Disorder, Mild, Uncomplicated, Except Cannabis ICD-10-CM
CMS-HCC Category 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.264 and 0.502 to a beneficiary's RAF score depending on the payment segment (0.423 for a community, non-dual, aged enrollee). 14 ICD-10-CM diagnosis codes map to HCC 138. A more severe related category (HCC 135, HCC 136, and HCC 137) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.423 |
| Community, partial-benefit dual, aged | 0.355 |
| Community, full-benefit dual, aged | 0.502 |
| Community, non-dual, disabled | 0.264 |
| Community, partial-benefit dual, disabled | 0.348 |
| Community, full-benefit dual, disabled | 0.384 |
| 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), HCC 136 (Alcohol Use with Psychotic Complications), and HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) supersede HCC 138 when reported together. HCC 138 in turn supersedes HCC 139 (Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications).
ICD-10-CM Codes That Map to HCC 138 14 codes
- F11.10 Opioid abuse, uncomplicated from V24 HCC 56
- F11.11 Opioid abuse, in remission from V24 HCC 56
- F13.10 Sedative, hypnotic or anxiolytic abuse, uncomplicated from V24 HCC 56
- F13.11 Sedative, hypnotic or anxiolytic abuse, in remission from V24 HCC 56
- F14.10 Cocaine abuse, uncomplicated from V24 HCC 56
- F14.11 Cocaine abuse, in remission from V24 HCC 56
- F15.10 Other stimulant abuse, uncomplicated from V24 HCC 56
- F15.11 Other stimulant abuse, in remission from V24 HCC 56
- F16.10 Hallucinogen abuse, uncomplicated from V24 HCC 56
- F16.11 Hallucinogen abuse, in remission from V24 HCC 56
- F18.10 Inhalant abuse, uncomplicated from V24 HCC 56
- F18.11 Inhalant abuse, in remission from V24 HCC 56
- F19.10 Other psychoactive substance abuse, uncomplicated from V24 HCC 56
- F19.11 Other psychoactive substance abuse, in remission from V24 HCC 56
Every code above carries the full HCC 138 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 138
What is HCC 138 in the CMS-HCC model?
HCC 138 is CMS-HCC Category 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis) in the V28 risk adjustment model. It covers 14 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 138?
For payment year 2026, HCC 138 adds 0.423 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.264 to 0.502 across the seven payment segments shown above.
Which categories supersede HCC 138?
HCC 135 (Drug Use with Psychotic Complications), HCC 136 (Alcohol Use with Psychotic Complications), and HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) sit above HCC 138 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.
