F31.5 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 · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF31.5

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mood [affective] disorders (F30-F39)

F31.5

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

Bipolar disorder, current episode depressed, severe, with psychotic features

Bipolar disorder with a severe depressive episode that includes psychotic features such as hallucinations or false beliefs.

Buddy Insight

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 152

Psychosis, Except Schizophrenia

Coefficient HCC 152: 0.484 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Context needed

HCC 088

Conditional HHS-HCC mapping: HCC 088 when age >= 2. Select the member context before showing a coefficient reference. Metal level and model segment are required for coefficients; no single RAF is shown.

Coefficient needs member context

ESRD/PACE

Context needed

HCC 59

ESRD candidates: HCC 59 when age >= 2 or age < 2. ESRD mapping is separate from PACE. Dialysis, graft, age, and other member context determine the applicable coefficient.

Coefficient needs member context

RXHCC

Mapped

HCC 131

Bipolar Disorders

Code-level coefficient reference

Code Book Path

Official

F31Bipolar disorder F31.5Bipolar disorder, current episode depressed, severe, with psychotic features

Inclusion Terms

Official

Bipolar disorder, current episode depressed with mood-incongruent psychotic symptoms
Bipolar disorder, current episode depressed with mood-congruent psychotic symptoms
Bipolar I disorder, current or most recent episode depressed, with psychotic features

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99, F31
cyclothymia (F34.0)Inherited from F01-F99, F31

Related Codes

Official

F31.0Bipolar disorder, current episode hypomanic F31.1Bipolar disorder, current episode manic without psychotic features F31.2Bipolar disorder, current episode manic severe with psychotic features F31.3Bipolar disorder, current episode depressed, mild or moderate severity F31.4Bipolar disorder, current episode depressed, severe, without psychotic features

Includes

Official

disorders of psychological developmentInherited from F01-F99, F31
bipolar I disorderInherited from F01-F99, F31
bipolar type I disorderInherited from F01-F99, F31
manic-depressive illnessInherited from F01-F99, F31
manic-depressive psychosisInherited from F01-F99, F31
manic-depressive reactionInherited from F01-F99, F31
seasonal bipolar disorderInherited from F01-F99, F31

Excludes 1

Official

bipolar disorder, single manic episode (F30.-)Inherited from F31
major depressive disorder, single episode (F32.-)Inherited from F31
major depressive disorder, recurrent (F33.-)Inherited from F31

Code First

Official

No Code First sequencing instructions are included in this display for F31.5. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F31.5. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F31.5. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Confirmed bipolar disorder diagnosis

Current depressive episode documented as severe

Specific psychotic features described: delusions (guilt, somatic, nihilistic) and/or hallucinations

Comprehensive suicide risk assessment

MEAT Support

HCC Buddy guidance

Confirmed bipolar disorder diagnosis

Current depressive episode documented as severe

Specific psychotic features described: delusions (guilt, somatic, nihilistic) and/or hallucinations

Comprehensive suicide risk assessment

Audit Caution

HCC Buddy guidance

Failing to identify mood-congruent psychotic features during depressive episodes (e.g., beliefs of deserving punishment, somatic delusions)

Confusing this with schizoaffective disorder — in bipolar with psychotic features, psychosis occurs only during mood episodes

Using this code when psychotic features have resolved but depression remains — downgrade to F31.4

Not documenting the specific type of psychotic features present

Common Mistakes

HCC Buddy guidance

F31.4 — Bipolar disorder, depressed, severe without psychotic features: No psychotic symptoms

F31.2 — Bipolar disorder, manic, severe with psychotic features: Manic rather than depressive episode

F32.3 — Major depressive disorder, single episode, severe with psychotic features: No bipolar history

F25.1 — Schizoaffective disorder, depressive type: Psychotic features persist between mood episodes

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 F31.5 an HCC code?

Yes. F31.5 (Bipolar disorder, current episode depressed, severe, with psychotic features) 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: F31.5 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: F31.5
Description: Bipolar disorder, current episode depressed, severe, with psychotic features
HCC (V28): HCC 152 — Psychosis, Except Schizophrenia
RAF reference coefficient: 0.484
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 152, Psychosis, Except Schizophrenia

0.484

RxHCCHCC 131, Bipolar Disorders

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 F31.5 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F31.5

For F31.5, 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

F31.5 is the ICD-10-CM diagnosis code for bipolar disorder, current episode depressed, severe, with psychotic features. Bipolar disorder with a severe depressive episode that includes psychotic features such as hallucinations or false beliefs. F31.5 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, F31.5 maps to Psychosis, Except Schizophrenia (HCC 152) with a source-labeled community, non-dual, aged reference coefficient of 0.484. 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.

Confirm documentation of both severe depression AND psychotic symptoms (hallucinations, delusions, or disorganized thinking). For F31.5, 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 F31.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Confirm documentation of both severe depression AND psychotic symptoms (hallucinations, delusions, or disorganized thinking)
•This code indicates more severe illness requiring closer monitoring and potentially different treatment approaches

Clinical Significance

Bipolar disorder with current severe depressive episode with psychotic features represents one of the most clinically acute psychiatric presentations, combining profound depression with psychotic symptoms such as mood-congruent delusions of guilt, worthlessness, or nihilism. This condition typically requires inpatient hospitalization and carries extremely high suicide risk. The psychotic component significantly increases treatment complexity and cost.

Documentation Requirements

✓Confirmed bipolar disorder diagnosis
✓Current depressive episode documented as severe
✓Specific psychotic features described: delusions (guilt, somatic, nihilistic) and/or hallucinations
✓Comprehensive suicide risk assessment
✓Mental status examination documenting psychotic features
✓Antipsychotic medication in addition to mood stabilizers
✓Hospitalization or crisis intervention documentation

Commonly Confused Codes

•F31.4: Bipolar disorder, depressed, severe without psychotic features: No psychotic symptoms
•F31.2: Bipolar disorder, manic, severe with psychotic features: Manic rather than depressive episode
•F32.3: Major depressive disorder, single episode, severe with psychotic features: No bipolar history
•F25.1: Schizoaffective disorder, depressive type: Psychotic features persist between mood episodes