What is ICD-10 code F25.0?

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 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F25.0 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. F25.0 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. F25.0 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 F25.0?

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 F25.0, 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 should coders know when reporting F25.0?

Schizoaffective disorder, bipolar type, meets schizophrenia criteria plus manic or mixed mood episodes. Distinguish from bipolar disorder with psychotic features, where psychotic symptoms occur only during mood episodes. The key schizoaffective criterion is psychotic symptoms present for > 2 weeks in the absence of mood symptoms at some point. Without that, the correct code is bipolar with psychotic features (F31.*). V28 HCC 151 at RAF 0.511. Because F25.0 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.

2026 ICD-10-CM F25.0: Schizoaffective disorder

ICD-10-CM Code View

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Code lookupF25.0Effective 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)

F25.0

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

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.

Buddy Insight

Schizoaffective disorder, bipolar type combines features of schizophrenia with bipolar manic episodes.

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

F25Schizoaffective disorders

F25.0Schizoaffective disorder, bipolar type

Inclusion Terms

Official

Cyclic schizophrenia
Schizoaffective disorder, manic type
Schizoaffective disorder, mixed type
Schizoaffective psychosis, bipolar type

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F25.0 in this effective period.

Related Child Codes

Official

F25.1Schizoaffective disorder, depressive type

F25.8Other schizoaffective disorders

F25.9Schizoaffective disorder, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F25.0 in this effective period.

Excludes 1

Official

mood [affective] disorders with psychotic symptoms (F30.2, F31.2, F31.5, F31.64, F32.3, F33.3)
schizophrenia (F20.-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F25.0 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F25.0 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F25.0 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Confusing schizoaffective disorder with bipolar disorder with psychotic features — the KEY distinction is whether psychosis occurs outside of mood episodes

Coding schizophrenia when mood episodes are a significant feature of the illness

Not specifying the bipolar vs. depressive type when documentation supports it

Using bipolar disorder codes when the patient has documented psychotic symptoms independent of mood episodes

Common Mistakes

HCC Buddy guidance

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

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 F25.0 an HCC code?

Yes. F25.0 (Schizoaffective disorder, bipolar type) 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: F25.0 is billable and maps to V28 HCC 151, Schizophrenia. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F25.0
Description: Schizoaffective disorder, bipolar type
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 F25.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 0.511. Under the older V24 model, F25.0 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.

Schizoaffective disorder, bipolar type, meets schizophrenia criteria plus manic or mixed mood episodes. Distinguish from bipolar disorder with psychotic features, where psychotic symptoms occur only during mood episodes. 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

•Schizoaffective disorder, bipolar type, meets schizophrenia criteria plus manic or mixed mood episodes. Distinguish from bipolar disorder with psychotic features, where psychotic symptoms occur only during mood episodes.
•The key schizoaffective criterion is psychotic symptoms present for > 2 weeks in the absence of mood symptoms at some point. Without that, the correct code is bipolar with psychotic features (F31.*).
•V28 HCC 151 at RAF 0.511.

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