F31.64
BillableBipolar disorder, current episode mixed, severe, with psychotic features
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F31.64 an HCC code?
Yes. F31.64 maps to Delusional and Other Specified Psychotic 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 F31.64
For F31.64 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 F31.64 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F31.64 is the ICD-10-CM diagnosis code for bipolar disorder, current episode mixed, severe, with psychotic features. Bipolar disorder with a severe mixed episode that includes both manic and depressive symptoms along with psychotic features like hallucinations or delusions. F31.64 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, F31.64 maps to Delusional and Other Specified Psychotic Disorders (HCC 152) with a community, non-dual, aged base RAF weight of 0.546. Under the older CMS-HCC V24 model, F31.64 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.
Requires documentation of severe mixed episode AND psychotic symptoms; this represents the most severe mixed presentation. Because F31.64 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 F31.64 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Requires documentation of severe mixed episode AND psychotic symptoms; this represents the most severe mixed presentation
- •Review mental status examination and psychiatric evaluation for evidence of psychotic features
Clinical Significance
Bipolar disorder with current severe mixed episode with psychotic features represents the most acute and dangerous bipolar presentation, combining simultaneous manic and depressive symptoms with psychotic features. This condition almost invariably requires inpatient psychiatric hospitalization and carries extreme risk for self-harm and dangerous behavior. The combination of psychotic thinking with mixed mood instability makes this one of the most challenging psychiatric emergencies.
Documentation Requirements
- ✓Confirmed bipolar disorder diagnosis
- ✓Concurrent severe manic and depressive symptoms documented
- ✓Specific psychotic features described (delusions, hallucinations) with notation of mood-congruent or mood-incongruent quality
- ✓Suicide and violence risk assessments
- ✓Mental status examination documenting psychosis
- ✓Antipsychotic and mood stabilizer medications prescribed
- ✓Hospitalization documentation