F25.9
BillableSchizoaffective disorder, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F25.9 an HCC code?
Yes. F25.9 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 F25.9
For F25.9 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 F25.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F25.9 is the ICD-10-CM diagnosis code for schizoaffective disorder, unspecified. A mental health condition combining psychotic symptoms with mood disturbances, but the specific type or pattern has not been clearly determined or documented. F25.9 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, F25.9 maps to Schizophrenia (HCC 151) with a community, non-dual, aged base RAF weight of 0.244. Under the older V24 model, F25.9 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.
This is a default code; work toward specifying the type (bipolar vs. depressive) with additional clinical information. Because F25.9 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 F25.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a default code; work toward specifying the type (bipolar vs. depressive) with additional clinical information
- •Query the provider if the schizoaffective subtype can be determined from the clinical presentation
Clinical Significance
Schizoaffective disorder, unspecified is used when the diagnosis of schizoaffective disorder is established but the specific type (bipolar vs. depressive) has not been determined or documented. This represents a documentation opportunity, as specifying the type improves clinical data quality for treatment planning and outcomes tracking. Despite being unspecified, it maps to the same high-value HCC as specified schizoaffective subtypes.
Documentation Requirements
- ✓Documented diagnosis of schizoaffective disorder by a qualified psychiatrist
- ✓Documentation of both psychotic and mood symptoms
- ✓Attempt to determine the specific subtype through provider query
- ✓Current symptom assessment and medication regimen
- ✓Functional impact assessment
- ✓Treatment plan addressing both psychotic and mood components
Commonly Confused Codes
- •F25.0 — Use when manic/bipolar mood episodes are the predominant mood feature
- •F25.1 — Use when depressive episodes are the predominant mood feature
- •F25.8 — Use when an atypical schizoaffective pattern is specifically identified
- •F20.9 — Schizophrenia, unspecified should be used when mood episodes are NOT a significant feature
- •F29 — Unspecified psychosis does not capture the schizoaffective diagnosis