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F25.1 ICD-10-CM Code: Schizoaffective disorder, depressive type

F25.1 maps to CMS-HCC V28 151. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupF25.1

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29)

F25.1

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

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.

Buddy the Bee presenting code insight

Buddy Insight

Schizoaffective disorder, depressive type combines features of schizophrenia with major depressive episodes.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 151

Coefficient HCC 151: 0.511 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

Context needed

HCC 087_1

Coefficient needs member context

ESRD/PACE

Context needed

HCC 57

Coefficient needs member context

RXHCC

HCC 130

Code-level coefficient reference

Code Book Path

Official
F25Schizoaffective disordersF25.1Schizoaffective disorder, depressive type

Inclusion Terms

Official
  • Schizoaffective psychosis, depressive type

Excludes 2

Official
  • symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official
F25.0Schizoaffective disorder, bipolar typeF25.8Other schizoaffective disordersF25.9Schizoaffective disorder, unspecified

Includes

Official
  • disorders of psychological developmentInherited from F01-F99

Excludes 1

Official
  • mood [affective] disorders with psychotic symptoms (F30.2, F31.2, F31.5, F31.64, F32.3, F33.3)Inherited from F25
  • schizophrenia (F20.-)Inherited from F25

Code First

Official

No Code First sequencing instructions are included in this display for F25.1. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F25.1. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F25.1. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
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

MEAT Support

HCC Buddy guidance
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

Audit Caution

HCC Buddy guidance
Confusing schizoaffective disorder, depressive type with major depressive disorder with psychotic features — the distinction is whether psychosis persists outside mood episodes
Coding schizophrenia when significant depressive episodes are part of the clinical picture
Not documenting that psychotic symptoms occur independently of mood episodes, which is the defining feature
Using unspecified schizoaffective codes when documentation supports the depressive type

Common Mistakes

HCC Buddy guidance
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

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 F25.1 an HCC code?

Yes. F25.1 (Schizoaffective disorder, depressive type) maps to HCC 151, Schizophrenia under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.511. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: F25.1 is billable and maps to V28 HCC 151, Schizophrenia. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
F25.1
Description
Schizoaffective disorder, depressive type
HCC (V28)
HCC 151 — Schizophrenia
RAF reference coefficient
0.511
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 151, Schizophrenia
0.511
RxHCCHCC 130, Schizophrenia and Other Psychosis
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work F25.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F25.1

For F25.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

  • 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

Coder workflow notes

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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 source-labeled community, non-dual, aged reference coefficient of 0.511. No V24 mapping is shown for F25.1; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Schizoaffective disorder, depressive type, meets schizophrenia criteria plus major depressive episodes (no manic episodes in history). Chart must support both the psychotic and the depressive components. For F25.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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

  • •Schizoaffective disorder, depressive type, meets schizophrenia criteria plus major depressive episodes (no manic episodes in history). Chart must support both the psychotic and the depressive components.
  • •Distinguish from MDD with psychotic features (F32.3/F33.3). Schizoaffective requires psychotic symptoms outside the mood episode window.

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

Child Codes

F25.0Schizoaffective disorder, bipolar type
HCC 151
F25.1Schizoaffective disorder, depressive type
HCC 151
F25.8Other schizoaffective disorders
HCC 151
F25.9Schizoaffective disorder, unspecified
HCC 151

Code Hierarchy

└F25Schizoaffective disorders└F25.1Schizoaffective disorder, depressive type
└F25.1Schizoaffective disorder, depressive type

Also searched as

  • F25 1
  • F251

For F25.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

F25.1 maps to CMS-HCC V28 category 151, Schizophrenia. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for F25.1. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

More on F25.1

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