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HCC 136: Alcohol Use with Psychotic Complications

HCC 136, Alcohol Use with Psychotic Complications, is one of the 115 payment categories in the CMS-HCC V28 model. 19 ICD-10-CM codes map to it in the payment year 2027 mapping, and a documented diagnosis in the category adds a relative factor of 0.424 to the risk score of a community, non-dual, aged beneficiary (0.637 disabled, 0.297 institutional). It is overridden when a more severe category in its hierarchy is present (HCC 135) and it in turn overrides HCC 137, HCC 138, HCC 139.

QuickIntell editorial content · Legacy registry date · Review not verified

Data effective
Data currency: ICD-10-CM to HCC mapping PY2027 initial (effective dates of service 2026, payment year 2027); CMS-HCC V28 model software V2826.115.T2 (effective payment year 2027). Next CMS release: PY2027 midyear final mapping (spring 2027) and PY2028 proposed model (February 2027).
Mapped ICD-10-CM codes
19
Factor, community non-dual aged
0.424
Factor, institutional
0.297
Hierarchy
Overridden by HCC 135
Disease group
SUD

Relative factors by segment

Each segment is a separate regression; the factor is added to the beneficiary's demographic factors and other categories, then normalized and reduced by the coding intensity adjustment before it meets the plan's base rate. A factor of 1.000 equals the expected cost of an average beneficiary.

CMS-HCC V28 relative factors for HCC 136 by model segment
SegmentModel codeRelative factor
Community, non-dual, agedCNA_HCC1360.424
Community, non-dual, disabledCND_HCC1360.637
Community, full-benefit dual, agedCFA_HCC1360.502
Community, full-benefit dual, disabledCFD_HCC1361.181
Community, partial-benefit dual, agedCPA_HCC1360.522
Community, partial-benefit dual, disabledCPD_HCC1360.922
Long-term institutionalINS_HCC1360.297

Hierarchy

Hierarchical condition categories pay only the most severe manifestation of a disease. When HCC 135 (Drug Use with Psychotic Complications) is also documented for the same beneficiary, HCC 136 is dropped from the score. When HCC 136 is present it drops HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications), HCC 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis), HCC 139 (Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications), so documenting the less severe condition alongside it adds nothing to payment but still matters for the clinical record.

HCC 135
Drug Use with Psychotic Complications · 97 codes · factor 0.424
HCC 137
Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications · 308 codes · factor 0.424
HCC 138
Drug Use Disorder, Mild, Uncomplicated, Except Cannabis · 14 codes · factor 0.423
HCC 139
Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications · 27 codes · factor 0.242

ICD-10-CM codes that map to HCC 136

19 codes map to this category in the PY2027 initial mapping. Descriptions are the CMS mapping descriptions for the FY2026 code set; a code that is deleted or split in the October code update stays valid for dates of service before the change.

ICD-10-CM codes mapped to HCC 136 in the CMS PY2027 initial mapping
ICD-10-CMDescription
F10131Alcohol abuse with withdrawal delirium
F10132Alcohol abuse with withdrawal with perceptual disturbance
F10150Alcohol abuse with alcohol-induced psychotic disorder with delusions
F10151Alcohol abuse with alcohol-induced psychotic disorder with hallucinations
F10159Alcohol abuse with alcohol-induced psychotic disorder, unspecified
F10231Alcohol dependence with withdrawal delirium
F10232Alcohol dependence with withdrawal with perceptual disturbance
F10250Alcohol dependence with alcohol-induced psychotic disorder with delusions
F10251Alcohol dependence with alcohol-induced psychotic disorder with hallucinations
F10259Alcohol dependence with alcohol-induced psychotic disorder, unspecified
F1026Alcohol dependence with alcohol-induced persisting amnestic disorder
F1027Alcohol dependence with alcohol-induced persisting dementia
F10931Alcohol use, unspecified with withdrawal delirium
F10932Alcohol use, unspecified with withdrawal with perceptual disturbance
F10950Alcohol use, unspecified with alcohol-induced psychotic disorder with delusions
F10951Alcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations
F10959Alcohol use, unspecified with alcohol-induced psychotic disorder, unspecified
F1096Alcohol use, unspecified with alcohol-induced persisting amnestic disorder
F1097Alcohol use, unspecified with alcohol-induced persisting dementia

Where these codes sat in the V22 model

The V28 recalibration renumbered and regrouped categories; this table shows which legacy V22 categories the same ICD-10 codes belonged to, which is the quickest way to reconcile a V22-era HCC gap list with the current model.

V22 categories that the HCC 136 codes mapped to
V22 HCCCodes
5419

Capturing and defending the category

A category counts for a payment year when a mapped diagnosis is documented at least once during the data collection year by an acceptable provider type at a face-to-face or audio-video encounter, and when the note shows the condition was monitored, evaluated, assessed or treated. Chronic conditions do not carry forward: a category that is not re-documented in the year drops out of the score, which is why annual wellness visits and problem-list reconciliation are where most recapture happens. Risk adjustment data validation audits sample enrollees and ask for the medical record behind each submitted category; an unsupported category is removed and, under the extrapolation rules, the error rate is applied across the contract. The QuickIntell risk adjustment product surfaces suspected and unsupported categories from the chart, and the HCC hub lists every V28 category with its factor and code count.

Frequently asked questions

Which ICD-10 codes map to HCC 136?

19 ICD-10-CM codes map to HCC 136 in the CMS PY2027 initial mapping, for example F10131 Alcohol abuse with withdrawal delirium; F10132 Alcohol abuse with withdrawal with perceptual disturbance; F10150 Alcohol abuse with alcohol-induced psychotic disorder with delusions; F10151 Alcohol abuse with alcohol-induced psychotic disorder with hallucinations. The full list is on this page; a code counts only when it is documented at a face-to-face or video encounter in the data collection year and supported by the record.

How much does HCC 136 add to a risk score?

The V28 relative factor for HCC 136 is 0.424 for a community, non-dual, aged beneficiary, 0.502 for full-benefit dual aged, 0.637 for non-dual disabled and 0.297 for long-term institutional members. A factor of 1.000 equals the expected annual cost of an average beneficiary, so the category's share of the payment follows the plan's base rate for that segment.

Does HCC 136 count together with related categories?

No. Within a hierarchy only the most severe category is paid. HCC 136 is dropped when HCC 135 (Drug Use with Psychotic Complications) is also present, and it drops HCC 137, HCC 138, HCC 139 when it is present.

What has to be documented for HCC 136 to be valid?

The diagnosis must be recorded by an acceptable provider type during a face-to-face or audio-video encounter in the service year, with the note showing that the condition was monitored, evaluated, assessed or treated. Risk adjustment data validation audits recover payment for categories the record does not support, so the code on the claim and the assessment in the note must match.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

Relative factors and mappings are reproduced from the CMS risk adjustment model files as an operational reference. Payment depends on the plan's base rate, normalization, the coding intensity adjustment and the enrollee's segment. Not legal, clinical or billing advice.