F32.3
BillableMajor depressive disorder, single episode, severe with psychotic features
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F32.3 an HCC code?
Yes. F32.3 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 F32.3
For F32.3 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 F32.3 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F32.3 is the ICD-10-CM diagnosis code for major depressive disorder, single episode, severe with psychotic features. A severe form of depression occurring as a single episode where the patient experiences psychotic symptoms such as hallucinations or delusions. This represents the most serious presentation of a first depressive episode. F32.3 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, F32.3 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, F32.3 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.
Verify documentation clearly states this is a single episode (not recurrent) and includes both severe depression AND psychotic features to justify this specific code. Because F32.3 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 F32.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation clearly states this is a single episode (not recurrent) and includes both severe depression AND psychotic features to justify this specific code
- •Ensure the psychotic features are documented as mood-congruent or mood-incongruent, and consider if additional codes are needed for specific psychotic symptoms
Clinical Significance
Major depressive disorder, single episode, severe with psychotic features represents a first-time psychotic depression, one of the most acute psychiatric presentations combining profound depression with psychotic symptoms. These patients are at extremely high suicide risk and almost always require inpatient hospitalization. Psychotic depression has a distinct neurobiology and treatment approach, typically requiring both antidepressant and antipsychotic medications.
Documentation Requirements
- ✓Provider documentation of major depressive disorder with full diagnostic criteria
- ✓Single episode confirmed — no prior depressive episodes
- ✓Severity documented as severe
- ✓Specific psychotic features documented: mood-congruent delusions (guilt, worthlessness, disease, poverty) and/or hallucinations
- ✓Mental status examination documenting psychotic findings
- ✓Suicide risk assessment
- ✓Antipsychotic medication prescribed alongside antidepressant
- ✓Hospitalization documentation if applicable