HCC 154: Bipolar Disorders without Psychosis ICD-10-CM
CMS-HCC Category 154 (Bipolar Disorders without Psychosis) is a payment HCC in the V28 Medicare Advantage risk adjustment model. For payment year 2026 it adds a risk adjustment factor between 0.108 and 0.351 to a beneficiary's RAF score depending on the payment segment (0.351 for a community, non-dual, aged enrollee). 27 ICD-10-CM diagnosis codes map to HCC 154. A more severe related category (HCC 151, HCC 152, and HCC 153) supersedes it when both are reported.
RAF Weight by Payment Segment 7 segments
| Payment Segment | Relative Factor |
|---|---|
| Community, non-dual, aged | 0.351 |
| Community, partial-benefit dual, aged | 0.314 |
| Community, full-benefit dual, aged | 0.349 |
| Community, non-dual, disabled | 0.166 |
| Community, partial-benefit dual, disabled | 0.108 |
| Community, full-benefit dual, disabled | 0.126 |
| Institutional | 0.199 |
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), HCC 152 (Psychosis, Except Schizophrenia), and HCC 153 (Personality Disorders; Anorexia/Bulimia Nervosa) supersede HCC 154 when reported together. HCC 154 in turn supersedes HCC 155 (Major Depression, Moderate or Severe, without Psychosis).
ICD-10-CM Codes That Map to HCC 154 27 codes
- F30.10 Manic episode without psychotic symptoms, unspecified from V24 HCC 59
- F30.11 Manic episode without psychotic symptoms, mild from V24 HCC 59
- F30.12 Manic episode without psychotic symptoms, moderate from V24 HCC 59
- F30.13 Manic episode, severe, without psychotic symptoms from V24 HCC 59
- F30.3 Manic episode in partial remission from V24 HCC 59
- F30.8 Other manic episodes from V24 HCC 59
- F30.9 Manic episode, unspecified from V24 HCC 59
- F31.0 Bipolar disorder, current episode hypomanic from V24 HCC 59
- F31.10 Bipolar disorder, current episode manic without psychotic features, unspecified from V24 HCC 59
- F31.11 Bipolar disorder, current episode manic without psychotic features, mild from V24 HCC 59
- F31.12 Bipolar disorder, current episode manic without psychotic features, moderate from V24 HCC 59
- F31.13 Bipolar disorder, current episode manic without psychotic features, severe from V24 HCC 59
- F31.30 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified from V24 HCC 59
- F31.31 Bipolar disorder, current episode depressed, mild from V24 HCC 59
- F31.32 Bipolar disorder, current episode depressed, moderate from V24 HCC 59
- F31.4 Bipolar disorder, current episode depressed, severe, without psychotic features from V24 HCC 59
- F31.60 Bipolar disorder, current episode mixed, unspecified from V24 HCC 59
- F31.61 Bipolar disorder, current episode mixed, mild from V24 HCC 59
- F31.62 Bipolar disorder, current episode mixed, moderate from V24 HCC 59
- F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features from V24 HCC 59
- F31.71 Bipolar disorder, in partial remission, most recent episode hypomanic from V24 HCC 59
- F31.73 Bipolar disorder, in partial remission, most recent episode manic from V24 HCC 59
- F31.75 Bipolar disorder, in partial remission, most recent episode depressed from V24 HCC 59
- F31.77 Bipolar disorder, in partial remission, most recent episode mixed from V24 HCC 59
- F31.81 Bipolar II disorder from V24 HCC 59
- F31.89 Other bipolar disorder from V24 HCC 59
- F31.9 Bipolar disorder, unspecified from V24 HCC 59
Every code above carries the full HCC 154 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 154
What is HCC 154 in the CMS-HCC model?
HCC 154 is CMS-HCC Category 154 (Bipolar Disorders without Psychosis) in the V28 risk adjustment model. It covers 27 ICD-10-CM diagnosis codes that raise a Medicare Advantage beneficiary's risk score when documented.
What is the RAF weight for HCC 154?
For payment year 2026, HCC 154 adds 0.351 to the RAF score of a community, non-dual, aged beneficiary. The published weights range from 0.108 to 0.351 across the seven payment segments shown above.
Which categories supersede HCC 154?
HCC 151 (Schizophrenia), HCC 152 (Psychosis, Except Schizophrenia), and HCC 153 (Personality Disorders; Anorexia/Bulimia Nervosa) sit above HCC 154 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.
