HCC 151: Schizophrenia ICD-10-CM
CMS-HCC Category 151 (Schizophrenia) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.304 and 0.591 to a beneficiary's RAF score depending on the payment segment (0.511 for a community, non-dual, aged enrollee). 12 ICD-10-CM diagnosis codes map to HCC 151. 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 | 0.511 |
| Community, partial-benefit dual, aged | 0.501 |
| Community, full-benefit dual, aged | 0.591 |
| Community, non-dual, disabled | 0.380 |
| Community, partial-benefit dual, disabled | 0.304 |
| Community, full-benefit dual, disabled | 0.414 |
| Institutional | 0.449 |
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 151 in turn supersedes HCC 152 (Psychosis, Except Schizophrenia), HCC 153 (Personality Disorders; Anorexia/Bulimia Nervosa), HCC 154 (Bipolar Disorders without Psychosis), and HCC 155 (Major Depression, Moderate or Severe, without Psychosis).
ICD-10-CM Codes That Map to HCC 151 12 codes
- F20.0 Paranoid schizophrenia from V24 HCC 57
- F20.1 Disorganized schizophrenia from V24 HCC 57
- F20.2 Catatonic schizophrenia from V24 HCC 57
- F20.3 Undifferentiated schizophrenia from V24 HCC 57
- F20.5 Residual schizophrenia from V24 HCC 57
- F20.81 Schizophreniform disorder from V24 HCC 57
- F20.89 Other schizophrenia from V24 HCC 57
- F20.9 Schizophrenia, unspecified from V24 HCC 57
- F25.0 Schizoaffective disorder, bipolar type from V24 HCC 57
- F25.1 Schizoaffective disorder, depressive type from V24 HCC 57
- F25.8 Other schizoaffective disorders from V24 HCC 57
- F25.9 Schizoaffective disorder, unspecified from V24 HCC 57
Every code above carries the full HCC 151 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 151
What is HCC 151 in the CMS-HCC model?
HCC 151 is CMS-HCC Category 151 (Schizophrenia) in the V28 risk adjustment model. It covers 12 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 151?
For payment year 2026, HCC 151 adds 0.511 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.304 to 0.591 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.
