Condition guide
Major Depressive Disorder HCC Coding Guide
Major Depressive Disorder (e.g. F32.1) maps to HCC 155 (Major Depression, Moderate or Severe, without Psychosis) under CMS-HCC V28. Its source-labeled community non-dual aged reference coefficient is 0.299. This is not a member total; full contribution depends on hierarchy, cleanup, interactions, member context, and model year. F32.0, major depressive disorder, single episode, mild, is non-HCC under V28. It can also map to HCC 152 (Psychosis, Except Schizophrenia) when the documentation supports those manifestations.
Quick Facts
HCC Categories
HCC 152, Psychosis, Except Schizophrenia
HCC 155, Major Depression, Moderate or Severe, without Psychosis
RAF Weight Range
0.299 to 0.484
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
6 ICD-10 codes map to payment HCCs
How coders write it
Chart notes, problem lists, and queries rarely spell out Major Depressive Disorder. The shorthand you will actually see:
Whatever the note calls it, the payment question is the same: how the ICD-10-CM code resolves to a payment HCC.
What HCC category does Major Depressive Disorder map to under V28?
Major depressive disorder is one of the most common behavioral health conditions in risk adjustment, with roughly 21 million US adults reporting a major depressive episode in a given year. Under CMS-HCC V28, these codes do not all land in one bucket. Moderate and severe-without-psychosis episodes (F32.1, F32.2, F33.1, F33.2) map to HCC 155, Major Depression, Moderate or Severe, without Psychosis (community non-dual aged RAF 0.299). Episodes with psychotic features (F32.3, F33.3) instead map to HCC 152, Psychosis, Except Schizophrenia (RAF 0.484). Mild episodes, remission codes, and unspecified depression (F32.9, F32.A) carry no V28 payment HCC, so documenting episode type, severity, and any psychotic features is what drives the correct category.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| F32.0 | Major depressive disorder, single episode, mild | Yes | No HCC (not risk-adjusting under V28) |
| 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 152 |
| F33.0 | Major depressive disorder, recurrent, mild | Yes | No HCC (not risk-adjusting under V28) |
| 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 152 |
| F33.40 | Major depressive disorder, recurrent, in remission, unspecified | Yes | No HCC (not risk-adjusting under V28) |
| F33.41 | Major depressive disorder, recurrent, in partial remission | Yes | No HCC (not risk-adjusting under V28) |
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verify Major Depressive Disorder against the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coder workflow notes
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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 as part of the documentation review.
Document whether the patient is in partial or full remission if the acute episode has resolved, but note that major depression remission codes carry no V28 payment HCC, so the documented active-episode severity is what drives capture.
Note any co-occurring anxiety, substance use, or psychotic features that may affect code selection.
MEAT documentation examples for Major Depressive Disorder
These examples organize documentation review using the MEAT review mnemonic for Major Depressive Disorder. Follow the applicable coding, encounter, program and payer requirements; these examples do not establish reportability on their own.
MMonitor
“PHQ-9 today 16, down from 21 at intake.”
“Sleep and appetite reviewed: early waking persists.”
“No suicidal ideation at today's visit; safety plan reviewed.”
EEvaluate
“Mental status exam: flat affect, slowed speech, fair insight.”
“Screened for bipolar features before adjusting therapy: negative.”
“Response after eight weeks on sertraline reviewed with patient.”
AAssess
“Major depressive disorder, recurrent, moderate; partial response to current dose.”
“MDD, single episode, severe without psychotic features.”
“MDD in partial remission; continue maintenance dosing.”
TTreat
“Sertraline increased to 150 mg daily.”
“Referred to cognitive behavioral therapy, biweekly.”
“Augmented with bupropion XL 150 mg each morning.”
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
In V28, depression is no longer a single broad payment category. CMS split it by severity and psychotic status: moderate and severe-without-psychosis episodes feed HCC 155, Major Depression, Moderate or Severe, without Psychosis (community non-dual aged RAF 0.299), while episodes with psychotic features route to HCC 152, Psychosis, Except Schizophrenia (RAF 0.484). Under V24 every one of these episodes, mild and remission codes included, shared HCC 59 (Major Depressive, Bipolar, and Paranoid Disorders) at 0.309. V28 dropped the mild episodes (F32.0, F33.0) and the remission codes (F33.40 through F33.42) from payment, and the unspecified codes F32.9 and F32.A never mapped in either model. Vague or low-severity documentation no longer earns an HCC, which makes documented severity the whole ballgame.
| Aspect | V24 (through PY2025) | V28 (PY2026) |
|---|---|---|
| Moderate and severe episodes (F32.1, F33.2) | HCC 59, Major Depressive, Bipolar, and Paranoid Disorders, RAF 0.309 | HCC 155, Major Depression Moderate or Severe without Psychosis, RAF 0.299 |
| Severe with psychotic features (F32.3, F33.3) | HCC 59, same category as every other episode, RAF 0.309 | HCC 152, Psychosis Except Schizophrenia, RAF 0.484 |
| Mild episodes (F32.0, F33.0) | HCC 59, RAF 0.309 | No payment HCC |
| Remission codes (F33.40, F33.41, F33.42) | HCC 59, RAF 0.309 | No payment HCC |
| Unspecified depression (F32.9, F32.A) | No payment HCC | No payment HCC |
These values are community, non-dual, aged code-level coefficient references for each model's payment year, not full member scores. For CMS-HCC V28 PY2026 member scoring with complete context, open the RAF Calculator. No score is shown unless every required source and calculation check passes.
Major Depressive Disorder coding FAQs
Does F32.9 risk-adjust?
No, and it never has: F32.9 (major depressive disorder, single episode, unspecified) carries no payment HCC under V28 or V24, and the same is true of F32.A (depression, unspecified). A payment HCC requires documented severity of at least moderate. When the note supports it, query for severity rather than defaulting to an unspecified code.
What severity does depression need to reach an HCC under V28?
Moderate or worse. F32.1 and F33.1 (moderate) and F32.2 and F33.2 (severe without psychotic features) map to HCC 155 at 0.299, and F32.3 and F33.3 (severe with psychotic features) map to HCC 152 at 0.484. Mild episodes stopped paying when V28 replaced V24.
Do remission codes still count for risk adjustment?
Not under V28. F33.40, F33.41, and F33.42 all mapped to V24 HCC 59 at 0.309 and now carry no payment HCC. Keep coding remission status accurately for clinical and quality purposes; just do not count on it for RAF.
Related Conditions
Related references
CMS-HCC V28 model
How V28 categories, source-labeled coefficient references, and hierarchy work for PY2026.
ICD-10 to HCC mapping
How an ICD-10-CM code resolves to a payment HCC under V28.
MEAT criteria
The documentation standard every coded condition must satisfy.
CMS-HCC V28 PY2026, complete member context required. No score is shown unless every required check passes.
Sources
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed September 5, 2026.
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