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Dementia HCCs in CMS-HCC V28 (HCC 125-127)

The dementia group of the CMS-HCC V28 model holds 3 payment categories (HCC 125, 126, 127): dementia by severity. 101 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Every category in the group carries the same community, non-dual, aged factor, 0.341. One hierarchy ranks HCC 125 > 126 > 127, so a member is paid for at most one category in the chain.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); CMS-HCC V28 model software: CMS-HCC V28 software V2826.115.T2 (PY2027 initial) (payment year 2027). Next CMS release: PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027).

Payment categories
3
Mapped ICD-10-CM codes
101
Factor range (CNA)
0.341 for every category
Hierarchies in the group
1
CMS hierarchy group "Cognitive"

Categories and relative factors

Each factor is added to the member's demographic factors when the category is documented in the data collection year. Community, non-dual, aged (CNA) is the largest segment; the disabled (CND) and long-term institutional (INS) segments are estimated separately, which is why the same category is worth a different amount for each.

CMS-HCC V28 dementia categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 125Dementia, Severe180.3410.2960.000
HCC 126Dementia, Moderate180.3410.2960.000
HCC 127Dementia, Mild or Unspecified650.3410.2960.000

Hierarchy inside the group

The V28 hierarchy macro ranks related categories so that a member with codes in several of them is paid only for the higher-ranked one. Each category drops only the categories its own macro entry lists.

Read each chain left to right: every category drops every category to its right, so a member is paid for at most one category per chain.

  • HCC 125 (Dementia, Severe) > HCC 126 (Dementia, Moderate) > HCC 127 (Dementia, Mild or Unspecified)

ICD-10-CM code families

Where the mapped codes concentrate. A family with many codes is usually where specificity matters most: the category only counts when the documented diagnosis supports the exact code reported.

Three-character ICD-10-CM categories with the most codes in the dementia group
ICD-10-CM categoryMapped codes
F0124
F0224
F0324
A8110
G917
G316
G304
G931

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. Every code in this group already had a V24 payment category. The main V24 sources are below; the crosswalk report covers every category.

V24 categories behind the dementia V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
51Dementia With Complications67
52Dementia Without Complication34

The CMS-HCC V24 vs V28 crosswalk shows the codes that lost or gained payment status across all categories.

Inpatient MS-DRGs that use these diagnoses

Appendix B of the v44 MS-DRG Definitions Manual names the DRGs whose logic uses each diagnosis. The same documentation supports the inpatient group and, for Medicare Advantage members, the risk score.

MS-DRGs whose logic lists the most dementia HCC codes
MS-DRGTitleShared codes
DRG 884Organic Disturbances and Intellectual Disability72
DRG 056Degenerative Nervous System Disorders with MCC28
DRG 057Degenerative Nervous System Disorders without MCC28
DRG 974HIV with Major Related Condition with MCC7
DRG 975HIV with Major Related Condition with CC7
DRG 976HIV with Major Related Condition without CC/MCC7
DRG 091Other Disorders of Nervous System with MCC1
DRG 092Other Disorders of Nervous System with CC1

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted no code mapped to this group, so its code lists carry into FY2027 unchanged until CMS posts a mapping for the new code set. The FY2027 code changes report lists every new and deleted code.

Where QuickIntell fits for dementia HCCs

An HCC counts only when the visit note supports it. QuickScribe captures the encounter documentation, and QuickCode supports qualified coder review and documentation clarification before diagnoses are submitted.

See QuickScribe for visit documentationSee QuickCode for coder reviewBook a meeting

Frequently asked questions

Which HCCs are in the V28 dementia group?

HCC 125 (Dementia, Severe, 18 codes, factor 0.341); HCC 126 (Dementia, Moderate, 18 codes, factor 0.341); HCC 127 (Dementia, Mild or Unspecified, 65 codes, factor 0.341).

Which dementia HCC has the most mapped ICD-10-CM codes?

HCC 127, Dementia, Mild or Unspecified, with 65 codes in the PY2027 initial mapping; across the group the largest code families are F01 (24), F02 (24), F03 (24), A81 (10).

Where did the dementia codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 101 code-to-category links point to this group; 0 of those codes had no V24 payment category. The main V24 sources were HCC 51 (Dementia With Complications, 67), HCC 52 (Dementia Without Complication, 34).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Factors, hierarchies and mappings are reproduced from the CMS risk adjustment model files as an operational reference. The group is a navigation aid built from the V28 hierarchy; CMS pays categories, not groups. Payment depends on the plan's base rate, normalization, the coding intensity adjustment and the enrollee's segment. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.