F25.0
BillableSchizoaffective disorder, bipolar type
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F25.0 an HCC code?
Yes. F25.0 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 F25.0
For F25.0 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 F25.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F25.0 is the ICD-10-CM diagnosis code for schizoaffective disorder, bipolar type. A mental health condition combining symptoms of schizophrenia with manic episodes, where the person experiences both psychotic symptoms and elevated mood or increased energy. F25.0 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, F25.0 maps to Schizophrenia (HCC 151) with a community, non-dual, aged base RAF weight of 0.244. Under the older V24 model, F25.0 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 temporal relationship between psychotic and manic symptoms. Because F25.0 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 F25.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the temporal relationship between psychotic and manic symptoms
- •Specify if the condition is in remission or active to support treatment planning
Clinical Significance
Schizoaffective disorder, bipolar type combines features of schizophrenia with bipolar manic episodes. Patients experience psychotic symptoms (hallucinations, delusions) alongside manic episodes (elevated mood, grandiosity, decreased sleep, increased activity). This is a complex and severe psychiatric diagnosis requiring both antipsychotic and mood-stabilizing medications. The dual nature of the illness significantly increases treatment complexity and healthcare utilization.
Documentation Requirements
- ✓Diagnosis by a qualified mental health professional (psychiatrist)
- ✓Documentation of psychotic symptoms occurring outside of mood episodes (key diagnostic criterion)
- ✓Description of manic episodes with elevated mood, grandiosity, decreased need for sleep, increased goal-directed activity
- ✓Documentation of concurrent psychotic and mood symptoms during episodes
- ✓Current medication regimen including both antipsychotic and mood-stabilizing agents
- ✓Functional assessment and treatment plan
Commonly Confused Codes
- •F25.1 — Schizoaffective disorder, DEPRESSIVE type involves depressive episodes rather than manic
- •F20.0 — Schizophrenia should be used when mood episodes are not a prominent feature
- •F31.2 — Bipolar disorder with psychotic features should be used when psychosis occurs ONLY during mood episodes
- •F25.9 — Schizoaffective disorder, unspecified should not be used when the bipolar type is documented
- •F30.2 — Manic episode with psychotic symptoms is for isolated episodes, not the schizoaffective pattern