F29 ICD-10-CM Code: Unspecified psychosis not due to a substance or known physiological condition
HCC Buddy Code Card
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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
RAF 0.484
CMS-HCC V24
MappedHCC 58
RAF 0.393
ACA/HHS
MappedHCC 87.2
Varies by metal level
ESRD/PACE
MappedHCC 58
RAF 0.111
RXHCC
MappedHCC 130
RAF 0.240
Code Book Path
Inclusion Terms
Official- Psychosis NOS
- Unspecified schizophrenia spectrum and other psychotic disorder
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for F29 in this effective period.
Related Child Codes
ICD-10-CM does not list child codes under F29 for this display context.
Includes
OfficialICD-10-CM does not list Includes notes for F29 in this effective period.
Excludes 1
Official- mental disorder NOS (F99)
- unspecified mental disorder due to known physiological condition (F09)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F29 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F29 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F29 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F29 an HCC code?
Yes. F29 maps to Psychosis, Except Schizophrenia under the CMS-HCC V28 risk adjustment model (and Reactive and Unspecified Psychosis under V24).
HCC Category Mapping
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 F29 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for F29
For F29to 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 F29 during that encounter, not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.484. Under the older CMS-HCC V24 model, F29 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.
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. Because F29 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 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