Major Depressive Disorder HCC Coding Guide
Complete HCC coding guide for Major Depressive Disorder (F32.x, F33.x) including ICD-10 to HCC mapping, V28 RAF weights, and episode documentation.
Quick Facts
HCC Categories
HCC 155 — Major Depressive and Bipolar Disorders
RAF Weight Range
0.309
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026 — 100% phase-in)
10 ICD-10 codes map to payment HCCs
Overview
Major depressive disorder is among the most prevalent behavioral health conditions affecting risk adjustment, with over 21 million US adults experiencing at least one episode annually. Under CMS-HCC V28, major depression maps to HCC 155 (Major Depressive and Bipolar Disorders). Coding accuracy depends on documenting whether the episode is single or recurrent (F32 vs. F33), the severity (mild, moderate, severe), and whether psychotic features are present. The distinction between major depressive disorder and other depressive conditions like persistent depressive disorder is critical, as only major depression maps to the payment HCC. Provider documentation must clearly state the diagnosis, current episode severity, and active treatment plan.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| F32.0 | Major depressive disorder, single episode, mild | Yes | HCC 155 |
| F32.1 | Major depressive disorder, single episode, moderate | Yes | HCC 155 |
| F32.2 | Major depressive disorder, single episode, severe without psychotic features | Yes | HCC 155 |
| F32.3 | Major depressive disorder, single episode, severe with psychotic features | Yes | HCC 155 |
| F33.0 | Major depressive disorder, recurrent, mild | Yes | HCC 155 |
| F33.1 | Major depressive disorder, recurrent, moderate | Yes | HCC 155 |
| F33.2 | Major depressive disorder, recurrent, severe without psychotic features | Yes | HCC 155 |
| F33.3 | Major depressive disorder, recurrent, severe with psychotic features | Yes | HCC 155 |
| F33.40 | Major depressive disorder, recurrent, in remission, unspecified | Yes | HCC 155 |
| F33.41 | Major depressive disorder, recurrent, in partial remission | Yes | HCC 155 |
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS rate announcement for payment calculations.
Documentation Tips
Clearly document 'major depressive disorder' — do not use vague terms like 'depression' or 'depressed mood' which may not support an MDD code.
Specify single episode (F32) vs. recurrent (F33) based on the patient's history of prior depressive episodes.
Document the current severity: mild, moderate, severe, or severe with psychotic features.
Include PHQ-9 score or other validated assessment tool results to support severity documentation.
Record current treatment: medication names, psychotherapy modality, and any treatment changes to satisfy MEAT criteria.
Document whether the patient is in partial or full remission if the acute episode has resolved — remission codes also map to HCC 155.
Note any co-occurring anxiety, substance use, or psychotic features that may affect code selection.
Common Coding Mistakes
Coding F32.A (depression, unspecified) or F32.9 instead of a specific severity code when the provider has documented mild, moderate, or severe depression.
Using 'recurrent' (F33) for a first-time episode, or 'single episode' (F32) for a patient with documented prior episodes.
Failing to capture psychotic features (F32.3 or F33.3) when documented, which reflects higher severity.
Confusing major depressive disorder with persistent depressive disorder (F34.1/dysthymia), which does not map to HCC 155 in V28.
V24 to V28 Changes
V28 created HCC 155 (Major Depressive and Bipolar Disorders), combining major depression with bipolar disorders into a single payment category. Under V24, major depression mapped to HCC 59 (Major Depressive, Bipolar, and Paranoid Disorders). The V28 recalibration narrowed the category scope but maintained major depression as a payment HCC. Notably, unspecified depression (F32.9, F32.A) was removed from payment HCC mapping in V28, making it essential to document specific severity levels.
Related Conditions
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