F31.13
BillableBipolar disorder, current episode manic without psychotic features, severe
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F31.13 an HCC code?
Yes. F31.13 maps to Bipolar Disorders under the CMS-HCC V28 risk adjustment model (and Major Depressive, Bipolar, and Paranoid Disorders 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 F31.13
For F31.13 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 F31.13 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F31.13 is the ICD-10-CM diagnosis code for bipolar disorder, current episode manic without psychotic features, severe. Bipolar disorder with a current severe manic episode without psychotic features, where the person experiences extreme elevated mood and increased activity with substantial functional impairment or risk of harm. F31.13 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mood [affective] disorders (f30-f39).
Under the CMS-HCC V28 risk adjustment model, F31.13 maps to Bipolar Disorders (HCC 154) with a community, non-dual, aged base RAF weight of 0.265. Under the older CMS-HCC V24 model, F31.13 maps to Major Depressive, Bipolar, and Paranoid Disorders (HCC 59) with a community, non-dual, aged base RAF weight of 0.309. 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.
Severe episodes typically require hospitalization or intensive treatment due to significant danger to self or others. Because F31.13 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 F31.13 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Severe episodes typically require hospitalization or intensive treatment due to significant danger to self or others
- •Document the severity of symptoms, functional impairment, and any safety concerns or treatment intensity required
Clinical Significance
Bipolar disorder with current severe manic episode without psychotic features represents one of the most acute non-psychotic presentations, often requiring intensive outpatient management or hospitalization. Severe mania carries high risk for dangerous behavior, financial recklessness, and complete disruption of daily functioning. Accurate capture is critical for reflecting true disease burden in risk adjustment.
Documentation Requirements
- ✓Confirmed bipolar disorder diagnosis with history
- ✓Current manic symptoms documented as severe by the provider
- ✓Explicit documentation that psychotic features are absent (no delusions, hallucinations)
- ✓Evidence of marked functional impairment or inability to function in daily activities
- ✓Hospitalization status or crisis intervention plan if applicable
- ✓Current psychiatric medication regimen and any emergency interventions
Commonly Confused Codes
- •F31.2 — Bipolar disorder, current episode manic severe with psychotic features: Requires additional psychotic symptom documentation
- •F31.12 — Bipolar disorder, current episode manic, moderate: Less severe impairment than F31.13
- •F31.63 — Bipolar disorder, current episode mixed, severe without psychotic features: Use when both manic and depressive symptoms are concurrent
- •F30.13 — Manic episode, severe without psychotic features: Use only for isolated manic episodes without bipolar history