What is ICD-10 code F28?

F28 is the ICD-10-CM diagnosis code for Other psychotic disorder not due to a substance or known physiological condition. A psychotic disorder where a person experiences hallucinations, delusions, or disorganized thinking that is not caused by substance use, medication, or a medical condition. F28 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F28 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. F28 is a payment HCC under the CMS risk adjustment model. Under the CMS-HCC V28 risk adjustment model it maps to Psychosis, Except Schizophrenia with a community, non-dual, aged base RAF weight of 0.484. Under the older CMS-HCC V24 model it maps to Reactive and Unspecified Psychosis at RAF 0.393. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. HCC Buddy maintains the V28 and V24 mapping, RAF weight, and MEAT documentation criteria for F28 sourced directly from the CMS-HCC model files.

Yes. F28 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. F28 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 F28?

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 F28, V28 maps to Psychosis, Except Schizophrenia at RAF 0.484 while V24 mapped to Reactive and Unspecified Psychosis at RAF 0.393. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F28?

Ensure documentation rules out substance use, medication effects, and medical causes before coding This is a diagnosis of exclusion; document the workup performed to eliminate other causes Because F28 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.

F28: Other psychotic disorder not due to a substance or known physiological condition — ICD-10

ICD-10-CM Code View

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Code lookupF28Effective 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)

F28

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

Other psychotic disorder not due to a substance or known physiological condition

A psychotic disorder where a person experiences hallucinations, delusions, or disorganized thinking that is not caused by substance use, medication, or a medical condition.

Buddy Insight

CMS-HCC V28

Mapped

HCC 152

Psychosis, Except Schizophrenia

RAF 0.484

CMS-HCC V24

Mapped

HCC 58

Reactive and Unspecified Psyc...

RAF 0.393

ACA/HHS

Mapped

HCC 87.2

HHS-HCC 87.2

Varies by metal level

ESRD/PACE

Mapped

HCC 58

Reactive and Unspecified Psyc...

RAF 0.111

RXHCC

Mapped

HCC 130

Schizophrenia

RAF 0.240

Code Book Path

Official

F2Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29)

F28Other psychotic disorder not due to a substance or known physiological condition

Inclusion Terms

Official

Chronic hallucinatory psychosis
Other specified schizophrenia spectrum and other psychotic disorder

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F28 in this effective period.

Related Child Codes

Official

ICD-10-CM does not list child codes under F28 for this display context.

Includes

Official

ICD-10-CM does not list Includes notes for F28 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F28 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F28 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F28 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F28 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of psychotic symptoms (hallucinations, delusions, disorganized thinking)

Assessment by a qualified mental health professional

Documentation ruling out substance-induced psychosis (drug screening, history)

Documentation ruling out psychosis due to medical conditions (metabolic, neurological, infectious workup)

MEAT Support

HCC Buddy guidance

Documentation of psychotic symptoms (hallucinations, delusions, disorganized thinking)

Assessment by a qualified mental health professional

Documentation ruling out substance-induced psychosis (drug screening, history)

Documentation ruling out psychosis due to medical conditions (metabolic, neurological, infectious workup)

Audit Caution

HCC Buddy guidance

Using F28 without documenting the exclusionary workup (substance use ruled out, medical causes ruled out)

Confusing 'other' psychotic disorder with 'unspecified' psychosis (F29) — different clinical implications

Not attempting to classify the psychosis more specifically before defaulting to this residual code

Coding F28 when symptoms actually fit a standard psychotic disorder category with further documentation review

Common Mistakes

HCC Buddy guidance

F29 — Unspecified psychosis is for when the type cannot be determined; F28 indicates a specific type was identified but does not fit standard categories

F20.89 — Other schizophrenia requires meeting full schizophrenia criteria; F28 does not

F22 — Delusional disorder involves only delusions; F28 may involve other psychotic features

F06.0/F06.2 — Psychotic disorders due to medical conditions should be used when an underlying medical cause is identified

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is F28 an HCC code?

Yes. F28 maps to Psychosis, Except Schizophrenia under the CMS-HCC V28 risk adjustment model (and Reactive and Unspecified Psychosis under V24).

HCC Category Mapping

V28HCC 152, Psychosis, Except Schizophrenia

0.484

V24HCC 58, Reactive and Unspecified Psychosis

0.393

ESRDHCC 58, Reactive and Unspecified Psychosis

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 F28 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for F28

For F28to 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 F28 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F28 is the ICD-10-CM diagnosis code for other psychotic disorder not due to a substance or known physiological condition. A psychotic disorder where a person experiences hallucinations, delusions, or disorganized thinking that is not caused by substance use, medication, or a medical condition. F28 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, F28 maps to Psychosis, Except Schizophrenia (HCC 152) with a community, non-dual, aged base RAF weight of 0.484. Under the older CMS-HCC V24 model, F28 maps to Reactive and Unspecified Psychosis (HCC 58) with a community, non-dual, aged base RAF weight of 0.393. 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.

Ensure documentation rules out substance use, medication effects, and medical causes before coding. Because F28 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 F28 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Ensure documentation rules out substance use, medication effects, and medical causes before coding
•This is a diagnosis of exclusion; document the workup performed to eliminate other causes

Clinical Significance

Other psychotic disorder not due to a substance or known physiological condition is a diagnosis of exclusion for psychotic presentations that do not fit standard categories (schizophrenia, delusional disorder, brief psychotic disorder, schizoaffective disorder). This may include chronic hallucinatory psychosis or other atypical psychotic presentations. It requires thorough clinical evaluation to exclude substance-induced and medical causes of psychosis. Accurate coding ensures these complex patients receive appropriate risk adjustment.

Documentation Requirements

✓Documentation of psychotic symptoms (hallucinations, delusions, disorganized thinking)
✓Assessment by a qualified mental health professional
✓Documentation ruling out substance-induced psychosis (drug screening, history)
✓Documentation ruling out psychosis due to medical conditions (metabolic, neurological, infectious workup)
✓Explanation of why the presentation does not fit schizophrenia, delusional disorder, brief psychotic disorder, or schizoaffective disorder
✓Current treatment plan and functional assessment

Commonly Confused Codes

•F29: Unspecified psychosis is for when the type cannot be determined; F28 indicates a specific type was identified but does not fit standard categories
•F20.89: Other schizophrenia requires meeting full schizophrenia criteria; F28 does not
•F22: Delusional disorder involves only delusions; F28 may involve other psychotic features
•F06.0/F06.2: Psychotic disorders due to medical conditions should be used when an underlying medical cause is identified
•F1X.950/F1X.951: Substance-induced psychotic disorders should be used when substance etiology is established

Code Hierarchy

└F28Other psychotic disorder not due to a substance or known physiological condition

F28 ICD-10-CM Code: Other psychotic disorder not due to a substance or known physiological condition

HCC Buddy Code Card

F28

Is F28 an HCC code?

HCC Category Mapping

MEAT Criteria for F28

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What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Commonly Confused Codes

Code Hierarchy

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