F25.1
BillableSchizoaffective disorder, depressive type
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F25.1 an HCC code?
Yes. F25.1 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 F25.1
For F25.1 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 F25.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F25.1 is the ICD-10-CM diagnosis code for schizoaffective disorder, depressive type. A mental health condition combining symptoms of schizophrenia with depressive episodes, where the person experiences both psychotic symptoms and persistent sadness or low mood. F25.1 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, F25.1 maps to Schizophrenia (HCC 151) with a community, non-dual, aged base RAF weight of 0.244. Under the older V24 model, F25.1 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.
Clearly document the presence of both psychotic and depressive symptoms occurring together. Because F25.1 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 F25.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Clearly document the presence of both psychotic and depressive symptoms occurring together
- •Distinguish from major depressive disorder with psychotic features by noting schizophrenic symptom prominence
Clinical Significance
Schizoaffective disorder, depressive type combines features of schizophrenia with major depressive episodes. Patients experience psychotic symptoms (hallucinations, delusions) alongside significant depressive episodes (persistent sadness, anhedonia, sleep/appetite changes, suicidal ideation). This is among the most challenging psychiatric diagnoses to manage, as both the psychotic and depressive components must be treated simultaneously, often with complex polypharmacy. The high suicide risk in these patients underscores the clinical importance of this diagnosis.
Documentation Requirements
- ✓Diagnosis by a qualified psychiatrist
- ✓Documentation of psychotic symptoms occurring outside of depressive episodes (essential criterion)
- ✓Description of major depressive episodes meeting diagnostic criteria
- ✓Documentation of concurrent psychotic and depressive symptoms during active episodes
- ✓Suicide risk assessment given the high-risk nature of this diagnosis
- ✓Current medication regimen and treatment response including antipsychotics and antidepressants
Commonly Confused Codes
- •F25.0 — Schizoaffective disorder, BIPOLAR type involves manic episodes rather than depressive
- •F32.3 — Major depressive disorder with psychotic features should be used when psychosis occurs ONLY during depressive episodes
- •F20.0 — Schizophrenia should be used when depressive episodes are not a prominent feature
- •F33.3 — Recurrent major depressive disorder with psychotic features involves psychosis limited to mood episodes
- •F25.9 — Schizoaffective disorder, unspecified should not be used when the depressive type is documented