What is ICD-10 code F20.3?

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. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F20.3 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F20.3 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. F20.3 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. F20.3 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.

Which HCC does F20.3 map to under V28?

F20.3 maps to CMS-HCC V28 151 (Schizophrenia). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does F20.3 pay in RAF?

F20.3 carries a community, non-dual, aged (CNA) RAF weight of 0.511 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for F20.3?

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 F20.3, V28 maps to Schizophrenia at RAF 0.511 while V24 mapped to Schizophrenia at RAF 0.524. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports F20.3?

Undifferentiated schizophrenia, psychotic symptoms meeting schizophrenia criteria but not matching any specific subtype. Used when symptoms do not clearly fit paranoid, disorganized, or catatonic patterns. Do not confuse with F20.9 (unspecified). Undifferentiated is a specific designation; unspecified means no subtype information is available. V28 HCC 151 at RAF 0.511. Because F20.3 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. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM F20.3: Undifferentiated

F20.3 maps to CMS-HCC V28 151 (RAF 0.511). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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 lookupF20.3Effective 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)

F20.3

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

Undifferentiated schizophrenia

A diagnosis of schizophrenia where the person has psychotic symptoms but does not clearly fit into the paranoid, disorganized, or catatonic subtypes.

Buddy Insight

CMS-HCC V28

Mapped

HCC 151

Schizophrenia

RAF 0.511

CMS-HCC V24

Mapped

HCC 57

Schizophrenia

RAF 0.524

ACA/HHS

Mapped

HCC 87.1

HHS-HCC 87.1

Varies by metal level

ESRD/PACE

Mapped

HCC 57

Schizophrenia

RAF 0.111

RXHCC

Mapped

HCC 130

Schizophrenia

RAF 0.240

Code Book Path

Official

F20Schizophrenia

F20.3Undifferentiated schizophrenia

Inclusion Terms

Official

Atypical schizophrenia

Excludes 2

Official

post-schizophrenic depression (F32.89)

Related Child Codes

Official

F20.0Paranoid schizophrenia

F20.1Disorganized schizophrenia

F20.2Catatonic schizophrenia

F20.5Residual schizophrenia

F20.8Other schizophrenia

Includes

Official

ICD-10-CM does not list Includes notes for F20.3 in this effective period.

Excludes 1

Official

acute schizophrenia-like psychotic disorder (F23)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F20.3 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 F20.3 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Using F20.3 when documentation actually supports a specific subtype (paranoid, disorganized, catatonic)

Confusing undifferentiated schizophrenia with unspecified schizophrenia (F20.9) — undifferentiated means assessed but not fitting one subtype

Not querying the provider about predominant features that might support a more specific subtype

Assigning this code based on outdated problem list entries without verifying current clinical status

Common Mistakes

HCC Buddy guidance

F20.0 — Use when paranoid features (delusions, auditory hallucinations) predominate

F20.1 — Use when disorganized speech and behavior predominate

F20.2 — Use when catatonic motor features predominate

F20.9 — Schizophrenia, unspecified is similar but F20.3 indicates the provider considered subtypes and found none clearly predominant

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 F20.3 an HCC code?

Yes. F20.3 (Undifferentiated schizophrenia) maps to Schizophrenia under the CMS-HCC V28 risk adjustment model (and Schizophrenia under V24), with a community non-dual aged RAF of 0.511. It is billable for payment year 2026.

Coder answer: F20.3 is billable and maps to V28 HCC 151, Schizophrenia. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F20.3
Description: Undifferentiated schizophrenia
HCC (V28): HCC 151 — Schizophrenia
RAF: 0.511
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 151, Schizophrenia

0.511

V24HCC 57, Schizophrenia

0.524

ESRDHCC 57, Schizophrenia

0.111

RxHCCHCC 130, Schizophrenia

0.240

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work F20.3 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 0.511. Under the older V24 model, F20.3 mapped to the same category but with a base RAF weight of 0.524, 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.

Undifferentiated schizophrenia, psychotic symptoms meeting schizophrenia criteria but not matching any specific subtype. Used when symptoms do not clearly fit paranoid, disorganized, or catatonic patterns. 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

•Undifferentiated schizophrenia, psychotic symptoms meeting schizophrenia criteria but not matching any specific subtype. Used when symptoms do not clearly fit paranoid, disorganized, or catatonic patterns.
•Do not confuse with F20.9 (unspecified). Undifferentiated is a specific designation; unspecified means no subtype information is available.
•V28 HCC 151 at RAF 0.511.

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)

Commonly Confused Codes

•F20.0: Use when paranoid features (delusions, auditory hallucinations) predominate
•F20.1: Use when disorganized speech and behavior predominate
•F20.2: Use when catatonic motor features predominate
•F20.9: Schizophrenia, unspecified is similar but F20.3 indicates the provider considered subtypes and found none clearly predominant
•F20.89: Other schizophrenia is for atypical presentations that fit a specific 'other' pattern