F20.0 ICD-10-CM Code: Paranoid schizophrenia
F20.0 maps to CMS-HCC V28 151. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29)
F20.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceParanoid schizophrenia
A type of schizophrenia where a person experiences prominent delusions and paranoia, often believing others are plotting against them or that they are being persecuted.
Buddy Insight
Paranoid schizophrenia is the most common subtype of schizophrenia, characterized by prominent persecutory or grandiose delusions and auditory hallucinations.
CMS-HCC V28
MappedHCC 151
Coefficient HCC 151: 0.511 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
Context neededHCC 087_1
Coefficient needs member context
ESRD/PACE
Context neededHCC 57
Coefficient needs member context
RXHCC
MappedHCC 130
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Paraphrenic schizophrenia
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99, F20
- schizophrenic reaction in:Inherited from F01-F99, F20
- alcoholism (F10.15-, F10.25-, F10.95-)Inherited from F01-F99, F20
- brain disease (F06.2)Inherited from F01-F99, F20
- epilepsy (F06.2)Inherited from F01-F99, F20
- psychoactive drug use (F11-F19 with .15. .25, .95)Inherited from F01-F99, F20
- schizotypal disorder (F21)Inherited from F01-F99, F20
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- involutional paranoid state (F22)
- paranoia (F22)
- brief psychotic disorder (F23)Inherited from F20
- cyclic schizophrenia (F25.0)Inherited from F20
- mood [affective] disorders with psychotic symptoms (F30.2, F31.2, F31.5, F31.64, F32.3, F33.3)Inherited from F20
- schizoaffective disorder (F25.-)Inherited from F20
- schizophrenic reaction NOS (F23)Inherited from F20
Code First
OfficialNo Code First sequencing instructions are included in this display for F20.0. Check the code and parent instructions in the Code Book.
Use Additional
Official- code, if applicable, to identify:Inherited from F20
- other specified cognitive deficit (R41.84-)Inherited from F20
Code Also
OfficialNo Code Also instructions are included in this display for F20.0. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F20.0 an HCC code?
Yes. F20.0 (Paranoid schizophrenia) maps to HCC 151, Schizophrenia under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.511. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: F20.0 is billable and maps to V28 HCC 151, Schizophrenia. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F20.0
- Description
- Paranoid schizophrenia
- HCC (V28)
- HCC 151 — Schizophrenia
- RAF reference coefficient
- 0.511
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work F20.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F20.0
For F20.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
F20.0 is the ICD-10-CM diagnosis code for paranoid schizophrenia. A type of schizophrenia where a person experiences prominent delusions and paranoia, often believing others are plotting against them or that they are being persecuted. F20.0 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (f20-f29).
Under the CMS-HCC V28 risk adjustment model, F20.0 maps to Schizophrenia (HCC 151) with a source-labeled community, non-dual, aged reference coefficient of 0.511. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Paranoid schizophrenia, predominant delusions or auditory hallucinations with relatively preserved cognition. Provider must document the paranoid subtype specifically or reference DSM diagnostic criteria. For F20.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for F20.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Paranoid schizophrenia, predominant delusions or auditory hallucinations with relatively preserved cognition. Provider must document the paranoid subtype specifically or reference DSM diagnostic criteria.
- •The F20 subtypes (paranoid, disorganized, catatonic) are DSM-IV legacy descriptors retained in ICD-10-CM. Documentation should match the subtype if the provider specifies it.
Clinical Significance
Paranoid schizophrenia is the most common subtype of schizophrenia, characterized by prominent persecutory or grandiose delusions and auditory hallucinations. This is a severe, chronic mental illness that profoundly impacts functioning and requires lifelong treatment with antipsychotic medications and psychosocial support. It carries a high HCC weight reflecting the intensive psychiatric care, frequent hospitalizations, and ongoing medication management these patients require.
Documentation Requirements
- ✓Documented diagnosis of schizophrenia with paranoid features by a qualified mental health professional
- ✓Description of specific paranoid symptoms (persecutory delusions, grandiose delusions, auditory hallucinations)
- ✓Assessment of current symptom status (active, partially controlled, in remission)
- ✓Current medication regimen including antipsychotic medications
- ✓Functional assessment documenting impact on daily activities, social functioning, and occupational capacity
- ✓Treatment plan including medication management and psychosocial interventions
Commonly Confused Codes
- •F22: Delusional disorder involves non-bizarre delusions without other prominent psychotic symptoms; schizophrenia involves broader psychotic features
- •F20.1: Disorganized schizophrenia has prominent disorganized speech and behavior rather than paranoid features
- •F20.3: Undifferentiated schizophrenia is used when no single subtype predominates
- •F20.9: Schizophrenia, unspecified should not be used when paranoid features are clearly documented
- •F25.0: Schizoaffective disorder, bipolar type combines schizophrenic and mood symptoms