What is ICD-10 code F31.64?

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 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F31.64 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F31.64 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F31.64 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does F31.64 map to under V28?

F31.64 maps to CMS-HCC V28 152 (Psychosis, Except Schizophrenia). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does F31.64 pay in RAF?

F31.64 carries a community, non-dual, aged (CNA) RAF weight of 0.484 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for F31.64?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F31.64, V28 maps to Psychosis, Except Schizophrenia at RAF 0.484 while V24 mapped to Major Depressive, Bipolar, and Paranoid Disorders at RAF 0.309. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports F31.64?

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 Because F31.64 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM F31.64: Bipolar disorder

F31.64 maps to CMS-HCC V28 152 (RAF 0.484). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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Code lookupF31.64Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

F31.64

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

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.

Buddy Insight

CMS-HCC V28

Mapped

HCC 152

Psychosis, Except Schizophrenia

RAF 0.484

CMS-HCC V24

Mapped

HCC 59

Major Depressive, Bipolar, an...

RAF 0.309

ACA/HHS

Mapped

HCC 88

HHS-HCC 88

Varies by metal level

ESRD/PACE

Mapped

HCC 59

Major Depressive, Bipolar, an...

RAF 0.066

RXHCC

Mapped

HCC 131

Bipolar Disorders

RAF 0.240

Code Book Path

Official

F31Bipolar disorder

F31.6Bipolar disorder, current episode mixed

F31.64Bipolar disorder, current episode mixed, severe, with psychotic features

Inclusion Terms

Official

Bipolar disorder, current episode mixed with mood-congruent psychotic symptoms
Bipolar disorder, current episode mixed with mood-incongruent psychotic symptoms

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F31.64 in this effective period.

Related Child Codes

Official

F31.60Bipolar disorder, current episode mixed, unspecified

F31.61Bipolar disorder, current episode mixed, mild

F31.62Bipolar disorder, current episode mixed, moderate

F31.63Bipolar disorder, current episode mixed, severe, without psychotic features

Includes

Official

ICD-10-CM does not list Includes notes for F31.64 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F31.64 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F31.64 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F31.64 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F31.64 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Failing to identify this as a mixed episode when both manic and depressive features are present alongside psychosis

Confusing with schizoaffective disorder — psychosis must be limited to mood episodes for bipolar coding

Not specifying the psychotic features in documentation

Coding as F31.2 (manic with psychosis) or F31.5 (depressed with psychosis) when the presentation is truly mixed

Common Mistakes

HCC Buddy guidance

F31.63 — Bipolar disorder, mixed, severe without psychotic features: No psychotic symptoms present

F31.2 — Bipolar disorder, manic, severe with psychotic features: Pure manic episode with psychosis

F31.5 — Bipolar disorder, depressed, severe with psychotic features: Pure depressive episode with psychosis

F25.0 — Schizoaffective disorder, bipolar type: Psychosis persists 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 F31.64 an HCC code?

Yes. F31.64 (Bipolar disorder, current episode mixed, severe, with psychotic features) maps to Psychosis, Except Schizophrenia under the CMS-HCC V28 risk adjustment model (and Major Depressive, Bipolar, and Paranoid Disorders under V24), with a community non-dual aged RAF of 0.484. It is billable for payment year 2026.

Coder answer: F31.64 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: F31.64
Description: Bipolar disorder, current episode mixed, severe, with psychotic features
HCC (V28): HCC 152 — Psychosis, Except Schizophrenia
RAF: 0.484
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 152, Psychosis, Except Schizophrenia

0.484

V24HCC 59, Major Depressive, Bipolar, and Paranoid Disorders

0.309

ESRDHCC 59, Major Depressive, Bipolar, and Paranoid Disorders

0.066

RxHCCHCC 131, Bipolar Disorders

0.240

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 F31.64 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 Psychosis, Except Schizophrenia (HCC 152) with a community, non-dual, aged base RAF weight of 0.484. 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

Commonly Confused Codes

•F31.63: Bipolar disorder, mixed, severe without psychotic features: No psychotic symptoms present
•F31.2: Bipolar disorder, manic, severe with psychotic features: Pure manic episode with psychosis
•F31.5: Bipolar disorder, depressed, severe with psychotic features: Pure depressive episode with psychosis
•F25.0: Schizoaffective disorder, bipolar type: Psychosis persists between mood episodes