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F25.9 ICD-10-CM Code: Schizoaffective disorder, unspecified

F25.9 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 Buddy coding tools

ICD-10-CM Code View

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Code lookupF25.9

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

F25.9

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

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.

Buddy the Bee presenting code insight

Buddy Insight

Schizoaffective disorder, unspecified is used when the diagnosis of schizoaffective disorder is established but the specific type (bipolar vs.

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 disordersF25.9Schizoaffective disorder, unspecified

Inclusion Terms

Official
  • Schizoaffective psychosis NOS

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 typeF25.1Schizoaffective disorder, depressive typeF25.8Other schizoaffective disorders

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 F25.9. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F25.9. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F25.9. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
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

MEAT Support

HCC Buddy guidance
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

Audit Caution

HCC Buddy guidance
Accepting this unspecified code without querying the provider about the predominant mood features
Using this code when documentation actually supports a specific subtype (bipolar or depressive)
Confusing schizoaffective disorder with schizophrenia or bipolar disorder — each has distinct diagnostic criteria
Not verifying that the diagnosis is from a qualified psychiatric provider rather than just a problem list entry

Common Mistakes

HCC Buddy guidance
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

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 F25.9 an HCC code?

Yes. F25.9 (Schizoaffective disorder, unspecified) 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: F25.9 is billable and maps to V28 HCC 151, Schizophrenia. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
F25.9
Description
Schizoaffective disorder, unspecified
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 F25.9 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F25.9

For F25.9, 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

F25.9 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 source-labeled community, non-dual, aged reference coefficient of 0.511. No V24 mapping is shown for F25.9; 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, unspecified, bipolar vs depressive type not specified. Query the provider to move to F25.0 or F25.1 when possible. For F25.9, 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 F25.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Schizoaffective disorder, unspecified, bipolar vs depressive type not specified. Query the provider to move to F25.0 or F25.1 when possible.
  • •Unspecified schizoaffective is common in EMR problem lists. Annual review by the psychiatrist typically supports a type specification.

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

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└F25.9Schizoaffective disorder, unspecified
└F25.9Schizoaffective disorder, unspecified

Also searched as

  • F25 9
  • F259

For F25.9, 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.

F25.9 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 F25.9. 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 F25.9

Related condition guides

Referenced in blog posts

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