F29 ICD-10-CM Code: Unspecified psychosis not due to a substance or known physiological condition
F29 maps to CMS-HCC V28 152. 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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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29)
F29
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified psychosis not due to a substance or known physiological condition
This code describes a mental health condition where a person experiences psychotic symptoms (such as hallucinations, delusions, or disorganized thinking) that cannot be attributed to drug use, alcohol, or a known medical condition. It is used when the specific type of psychosis cannot be determined or classified more precisely.
Buddy Insight
Unspecified psychosis not due to a substance or known physiological condition is used when a patient has documented psychotic symptoms but the specific type of psychotic disorder cannot be determined.
CMS-HCC V28
MappedHCC 152
Coefficient HCC 152: 0.484 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
Context neededHCC 087_2
Coefficient needs member context
ESRD/PACE
Context neededHCC 58
Coefficient needs member context
RXHCC
MappedHCC 130
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Psychosis NOS
- Unspecified schizophrenia spectrum and other psychotic disorder
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
No related codes are included in this display for F29. Check the Code Book for the complete code path.
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- mental disorder NOS (F99)
- unspecified mental disorder due to known physiological condition (F09)
Code First
OfficialNo Code First sequencing instructions are included in this display for F29. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F29. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F29. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F29 an HCC code?
Yes. F29 (Unspecified psychosis not due to a substance or known physiological condition) maps to HCC 152, Psychosis, Except Schizophrenia under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.484. 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: F29 is billable and maps to V28 HCC 152, Psychosis, Except Schizophrenia. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F29
- Description
- Unspecified psychosis not due to a substance or known physiological condition
- HCC (V28)
- HCC 152 — Psychosis, Except Schizophrenia
- RAF reference coefficient
- 0.484
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 F29 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F29
For F29, 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
F29 is the ICD-10-CM diagnosis code for unspecified psychosis not due to a substance or known physiological condition. This code describes a mental health condition where a person experiences psychotic symptoms (such as hallucinations, delusions, or disorganized thinking) that cannot be attributed to drug use, alcohol, or a known medical condition. It is used when the specific type of psychosis cannot be determined or classified more precisely. F29 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, F29 maps to Psychosis, Except Schizophrenia (HCC 152) with a source-labeled community, non-dual, aged reference coefficient of 0.484. No V24 mapping is shown for F29; 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.
Use F29 only when psychosis is documented but the underlying cause is unclear or cannot be specified; always investigate and document whether symptoms are related to substance use, medical conditions, or other psychotic disorders before assigning this code. For F29, 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 F29 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use F29 only when psychosis is documented but the underlying cause is unclear or cannot be specified; always investigate and document whether symptoms are related to substance use, medical conditions, or other psychotic disorders before assigning this code
- •This is a non-specific code; attempt to obtain more detailed clinical information to assign a more specific psychotic disorder code (such as F20-F28 range) when possible, as F29 may trigger additional documentation requests from payers
Clinical Significance
Unspecified psychosis not due to a substance or known physiological condition is used when a patient has documented psychotic symptoms but the specific type of psychotic disorder cannot be determined. This is often an early or provisional diagnosis used during initial evaluation. While it captures a high-value HCC, clinical best practice calls for working toward a more specific diagnosis (schizophrenia, delusional disorder, etc.) as the clinical picture clarifies over time.
Documentation Requirements
- ✓Documentation of psychotic symptoms (hallucinations, delusions, disorganized thinking/behavior)
- ✓Assessment by a qualified mental health professional
- ✓Documentation that substance-induced and medical causes have been considered or ruled out
- ✓Explanation of why a more specific psychotic disorder diagnosis cannot yet be assigned
- ✓Plan for ongoing evaluation to refine the diagnosis over time
- ✓Current treatment plan including any antipsychotic medications
Excludes 1, Do NOT code together
Commonly Confused Codes
- •F28: OTHER specified psychotic disorder indicates a specific type was identified; F29 means the type is undetermined
- •F20.9: Schizophrenia, unspecified requires meeting schizophrenia criteria; F29 has not reached that diagnostic conclusion
- •F23: Brief psychotic disorder should be used when symptoms resolve within one month
- •F06.2: Psychotic disorder due to medical condition should be used when a medical cause is identified
- •R44.3: Hallucinations, unspecified is a symptom code, not a diagnosis; use F29 when a psychotic disorder diagnosis is established