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