F06.2 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupF06.2

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental disorders due to known physiological conditions (F01-F09)

F06.2

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Psychotic disorder with delusions due to known physiological condition

Delusions or false beliefs that develop as a direct result of a known medical condition affecting the brain or body.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F06Other mental disorders due to known physiological condition F06.2Psychotic disorder with delusions due to known physiological condition

Inclusion Terms

Official

Paranoid and paranoid-hallucinatory organic states
Schizophrenia-like psychosis in epilepsy

Excludes 2

Official

alcohol and drug-induced psychotic disorder (F10-F19 with .150, .250, .950)
brief psychotic disorder (F23)
delusional disorder (F22)
schizophrenia (F20.-)
symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99, F06
delirium due to known physiological condition (F05)Inherited from F01-F99, F06
dementia as classified in F01-F02Inherited from F01-F99, F06
other mental disorders associated with alcohol and other psychoactive substances (F10-F19)Inherited from F01-F99, F06

Related Codes

Official

F06.0Psychotic disorder with hallucinations due to known physiological condition F06.1Catatonic disorder due to known physiological condition F06.3Mood disorder due to known physiological condition F06.4Anxiety disorder due to known physiological condition F06.7Mild neurocognitive disorder due to known physiological condition

Includes

Official

disorders of psychological developmentInherited from F01-F99, F06
mental disorders due to endocrine disorderInherited from F01-F99, F06
mental disorders due to exogenous hormoneInherited from F01-F99, F06
mental disorders due to exogenous toxic substanceInherited from F01-F99, F06
mental disorders due to primary cerebral diseaseInherited from F01-F99, F06
mental disorders due to somatic illnessInherited from F01-F99, F06
mental disorders due to systemic disease affecting the brainInherited from F01-F99, F06

Excludes 1

Official

unspecified dementia (F03.-)Inherited from F06

Code First

Official

the underlying physiological conditionInherited from F06

Use Additional

Official

No Use Additional Code instructions are included in this display for F06.2. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F06.2. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Identify and document the specific physiological cause (e.g., infection, metabolic disorder, neurological disease)

Do not use this code if delusions are primary psychiatric symptoms; ensure medical causation is established

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is F06.2 an HCC code?

No. F06.2 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: F06.2
Description: Psychotic disorder with delusions due to known physiological condition
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

F06.2 is the ICD-10-CM diagnosis code for psychotic disorder with delusions due to known physiological condition. Delusions or false beliefs that develop as a direct result of a known medical condition affecting the brain or body. F06.2 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental disorders due to known physiological conditions (f01-f09).

F06.2 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Identify and document the specific physiological cause (e.g., infection, metabolic disorder, neurological disease).

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for F06.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Identify and document the specific physiological cause (e.g., infection, metabolic disorder, neurological disease)
•Do not use this code if delusions are primary psychiatric symptoms; ensure medical causation is established