What is ICD-10 code F20.0?

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. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F20.0 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F20.0 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F20.0 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F20.0 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F20.0?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F20.0, V28 maps to Schizophrenia at RAF 0.244 while V24 mapped to Schizophrenia at RAF 0.508. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F20.0?

Document the specific nature of paranoid delusions in the clinical record to support accurate coding Distinguish from other schizophrenia subtypes by confirming paranoia is the dominant feature Because F20.0 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

F20.0 ICD-10 Code: Paranoid schizophrenia

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF20.0Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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 guidance

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.

Buddy Insight

Paranoid schizophrenia is the most common subtype of schizophrenia, characterized by prominent persecutory or grandiose delusions and auditory hallucinations.

CMS-HCC V28

Mapped

HCC 151

Schizophrenia

RAF 0.244

CMS-HCC V24

Mapped

HCC 57

Schizophrenia

RAF 0.508

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 57

Schizophrenia

RAF 0.0

RXHCC

Mapped

HCC 130

Schizophrenia

RAF 0.0

Code Trumping

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Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

F20Schizophrenia

F20.0Paranoid schizophrenia

Inclusion Terms

Official

Paraphrenic schizophrenia

Excludes 2

Official

schizophrenic reaction in:
alcoholism (F10.15-, F10.25-, F10.95-)
brain disease (F06.2)
epilepsy (F06.2)
psychoactive drug use (F11-F19 with .15. .25, .95)

Related Child Codes

Official

F20.1Disorganized schizophrenia

F20.2Catatonic schizophrenia

F20.3Undifferentiated schizophrenia

F20.5Residual schizophrenia

F20.8Other schizophrenia

Includes

Official

ICD-10-CM does not list Includes notes for F20.0 in this effective period.

Excludes 1

Official

involutional paranoid state (F22)
paranoia (F22)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F20.0 in this effective period.

Use Additional

Official

code, if applicable, to identify:
other specified cognitive deficit (R41.84-)

Code Also

Official

ICD-10-CM does not list Code Also instructions for F20.0 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Using unspecified schizophrenia (F20.9) when the provider has documented paranoid features that support F20.0

Confusing paranoid schizophrenia with delusional disorder — schizophrenia involves additional psychotic features beyond delusions alone

Not verifying that the diagnosis was made by a qualified provider (psychiatrist, psychologist) rather than just documented in the problem list

Failing to distinguish between substance-induced psychosis with paranoid features (F1X.X50) and true paranoid schizophrenia

Common Mistakes

HCC Buddy guidance

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

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is F20.0 an HCC code?

Yes. F20.0 maps to Schizophrenia under the CMS-HCC V28 risk adjustment model (and Schizophrenia under V24).

HCC Category Mapping

V28HCC 151, Schizophrenia

0.244

V24HCC 57, Schizophrenia

0.508

ESRDHCC 57, Schizophrenia

0.000

RxHCCHCC 130, Schizophrenia

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for F20.0

For F20.0to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

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

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F20.0 during that encounter, not just copy-forwarded from a problem list.

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 community, non-dual, aged base RAF weight of 0.244. Under the older V24 model, F20.0 mapped to the same category but with a base RAF weight of 0.508, V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Document the specific nature of paranoid delusions in the clinical record to support accurate coding. Because F20.0 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, 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

•Document the specific nature of paranoid delusions in the clinical record to support accurate coding
•Distinguish from other schizophrenia subtypes by confirming paranoia is the dominant feature

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

Excludes 1, Do NOT code together

involutional paranoid state (F22)
paranoia (F22)

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