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Psychiatric HCCs in CMS-HCC V28 (HCC 151-155)

The psychiatric group of the CMS-HCC V28 model holds 5 payment categories (HCC 151, 152, 153, 154, 155): schizophrenia, psychosis, bipolar, personality disorders and major depression. 457 ICD-10-CM codes map to them in the payment year 2027 initial mapping. Community, non-dual, aged factors run from 0.299 (HCC 155) to 0.511 (HCC 151). One hierarchy ranks HCC 151 > 152 > 153 > 154 > 155, 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
5
Mapped ICD-10-CM codes
457
Factor range (CNA)
0.299 to 0.511
Hierarchies in the group
1
CMS hierarchy group "Psychiatric"

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 psychiatric categories with relative factors
HCCCategoryCodesCNACNDINS
HCC 151Schizophrenia120.5110.3800.449
HCC 152Psychosis, Except Schizophrenia120.4840.2900.208
HCC 153Personality Disorders; Anorexia/Bulimia Nervosa350.3960.2900.199
HCC 154Bipolar Disorders without Psychosis270.3510.1660.199
HCC 155Major Depression, Moderate or Severe, without Psychosis3710.2990.1660.199

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 151 (Schizophrenia) > HCC 152 (Psychosis, Except Schizophrenia) > HCC 153 (Personality Disorders; Anorexia/Bulimia Nervosa) > HCC 154 (Bipolar Disorders without Psychosis) > HCC 155 (Major Depression, Moderate or Severe, without Psychosis)

Interaction terms that involve this group

V28 pays an extra factor when two condition groups are documented together, on top of each category's own factor. A blank cell means the segment carries no such term.

V28 interaction factors involving psychiatric categories
InteractionCNACNDINS
Substance use disorder and psychiatric condition0.087

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 psychiatric group
ICD-10-CM categoryMapped codes
T6338
F3123
T4320
F5019
T5019
T4015
T4515
T6515

Where these codes sat in V24

The payment year 2025 mapping lists the V24 and V28 category for the same codes. 22 codes in this group had no V24 payment category. The main V24 sources are below; the crosswalk report covers every category.

V24 categories behind the psychiatric V28 categories (PY2025 mapping)
V24 HCCV24 categoryCodes
59Major Depressive, Bipolar, and Paranoid Disorders404
60Personality Disorders16
57Schizophrenia12
58Reactive and Unspecified Psychosis4

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 psychiatric HCC codes
MS-DRGTitleShared codes
DRG 917Poisoning and Toxic Effects of Drugs with MCC313
DRG 918Poisoning and Toxic Effects of Drugs without MCC313
DRG 885Psychoses55
DRG 883Disorders of Personality and Impulse Control27
DRG 922Other Injury, Poisoning and Toxic Effect Diagnoses with MCC8
DRG 923Other Injury, Poisoning and Toxic Effect Diagnoses without MCC8
DRG 887Other Mental Disorder Diagnoses6
DRG 928Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC3

FY2027 code changes in this group

The October 1, 2026 ICD-10-CM update deleted 1 code mapped to this group and created 5 replacement codes whose predecessors map here. CMS has not mapped the new codes yet; each category page lists them as pending. The FY2027 code changes report lists every new and deleted code.

Where QuickIntell fits for psychiatric 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 psychiatric group?

HCC 151 (Schizophrenia, 12 codes, factor 0.511); HCC 152 (Psychosis, Except Schizophrenia, 12 codes, factor 0.484); HCC 153 (Personality Disorders; Anorexia/Bulimia Nervosa, 35 codes, factor 0.396); HCC 154 (Bipolar Disorders without Psychosis, 27 codes, factor 0.351); HCC 155 (Major Depression, Moderate or Severe, without Psychosis, 371 codes, factor 0.299).

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

HCC 155, Major Depression, Moderate or Severe, without Psychosis, with 371 codes in the PY2027 initial mapping; across the group the largest code families are T63 (38), F31 (23), T43 (20), F50 (19).

Where did the psychiatric codes sit in the V24 model?

In the PY2025 mapping, which carries both models, 458 code-to-category links point to this group; 22 of those codes had no V24 payment category. The main V24 sources were HCC 59 (Major Depressive, Bipolar, and Paranoid Disorders, 404), HCC 60 (Personality Disorders, 16), HCC 57 (Schizophrenia, 12).

Do psychiatric HCCs interact with other conditions in V28?

Yes. Substance use disorder and psychiatric condition adds 0.087 (community, non-dual, disabled; the term exists only for disabled community members). Each term is added on top of the category factors when both conditions are documented.

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.