HCC 152: Psychosis, Except Schizophrenia ICD-10-CM
CMS-HCC Category 152 (Psychosis, Except Schizophrenia) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.208 and 0.579 to a beneficiary's RAF score depending on the payment segment (0.484 for a community, non-dual, aged enrollee). 12 ICD-10-CM diagnosis codes map to HCC 152. A more severe related category (HCC 151) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.484 |
| Community, partial-benefit dual, aged | 0.501 |
| Community, full-benefit dual, aged | 0.579 |
| Community, non-dual, disabled | 0.290 |
| Community, partial-benefit dual, disabled | 0.247 |
| Community, full-benefit dual, disabled | 0.255 |
| Institutional | 0.208 |
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 151 (Schizophrenia) supersedes HCC 152 when reported together. HCC 152 in turn supersedes 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 152 12 codes
- F22 Delusional disorders from V24 HCC 59
- F23 Brief psychotic disorder from V24 HCC 58
- F24 Shared psychotic disorder from V24 HCC 59
- F28 Other psychotic disorder not due to a substance or known physiological condition from V24 HCC 58
- F29 Unspecified psychosis not due to a substance or known physiological condition from V24 HCC 58
- F30.2 Manic episode, severe with psychotic symptoms from V24 HCC 59
- F31.2 Bipolar disorder, current episode manic severe with psychotic features from V24 HCC 59
- F31.5 Bipolar disorder, current episode depressed, severe, with psychotic features from V24 HCC 59
- F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features from V24 HCC 59
- F32.3 Major depressive disorder, single episode, severe with psychotic features from V24 HCC 59
- F33.3 Major depressive disorder, recurrent, severe with psychotic symptoms from V24 HCC 59
- F53.1 Puerperal psychosis from V24 HCC 58
Every code above carries the full HCC 152 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 152
What is HCC 152 in the CMS-HCC model?
HCC 152 is CMS-HCC Category 152 (Psychosis, Except 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 152?
For payment year 2026, HCC 152 adds 0.484 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.208 to 0.579 across the seven payment segments shown above.
Which categories supersede HCC 152?
HCC 151 (Schizophrenia) sits above HCC 152 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.
