F20.3
BillableUndifferentiated schizophrenia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F20.3 an HCC code?
Yes. F20.3 maps to Schizophrenia under the CMS-HCC V28 risk adjustment model (and Schizophrenia under V24).
HCC Category Mapping
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 F20.3
For F20.3 to 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 F20.3 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F20.3 is the ICD-10-CM diagnosis code for undifferentiated schizophrenia. A diagnosis of schizophrenia where the person has psychotic symptoms but does not clearly fit into the paranoid, disorganized, or catatonic subtypes. F20.3 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, F20.3 maps to Schizophrenia (HCC 151) with a community, non-dual, aged base RAF weight of 0.244. Under the older V24 model, F20.3 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.
Use this code when schizophrenia is present but specific subtype criteria are not clearly met. Because F20.3 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 F20.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when schizophrenia is present but specific subtype criteria are not clearly met
- •Document the presence of psychotic symptoms even if they don't fit neatly into other categories
Clinical Significance
Undifferentiated schizophrenia is diagnosed when a patient meets general schizophrenia criteria but does not clearly fit the paranoid, disorganized, or catatonic subtypes, or when features of multiple subtypes are present. This diagnosis reflects the heterogeneity of schizophrenia presentations. It carries the same high HCC weight as other schizophrenia subtypes, reflecting the severe, chronic nature of the illness regardless of the specific symptom pattern.
Documentation Requirements
- ✓Diagnosis of schizophrenia by a qualified mental health professional
- ✓Documentation of psychotic symptoms (delusions, hallucinations, disorganized speech or behavior)
- ✓Assessment indicating the presentation does not clearly fit paranoid, disorganized, or catatonic criteria
- ✓Current symptom assessment and severity
- ✓Medication regimen and treatment response
- ✓Functional impact on daily activities, social, and occupational functioning
Excludes 1 — Do NOT code together
- acute schizophrenia-like psychotic disorder (F23)
Excludes 2 — Not included here, may code separately
- post-schizophrenic depression (F32.89)