What is ICD-10 code F32.3?

F32.3 is the ICD-10-CM diagnosis code for Major depressive disorder, single episode, severe with psychotic features. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F32.3 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F32.3 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. F32.3 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. F32.3 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.

What is the V28 vs V24 difference for F32.3?

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 F32.3, 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 should coders know when reporting F32.3?

MDD, single episode, severe with psychotic features, requires documentation of psychotic features (delusions, hallucinations) in the context of the depressive episode. Specific to single-episode MDD. Psychotic features must be attributed to the MDD, not to a primary psychotic disorder (F20-F29). If schizophrenia or schizoaffective disorder is documented, those codes take precedence. V28 HCC 152 (Psychosis, Except Schizophrenia) at RAF 0.484. MDD with psychotic features maps to the psychosis HCC, which outweighs and supersedes the moderate/severe depression HCC 155. Because F32.3 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.

2026 ICD-10-CM F32.3: Major depressive disorder

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Code lookupF32.3Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

F32.3

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

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.

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 132

Major Depressive Disorder and...

RAF 0.070

Code Book Path

Official

F32Depressive episode

F32.3Major depressive disorder, single episode, severe with psychotic features

Inclusion Terms

Official

Single episode of major depression with mood-congruent psychotic symptoms
Single episode of major depression with mood-incongruent psychotic symptoms
Single episode of major depression with psychotic symptoms
Single episode of psychogenic depressive psychosis
Single episode of psychotic depression

Excludes 2

Official

adjustment disorder (F43.2)

Related Child Codes

Official

F32.0Major depressive disorder, single episode, mild

F32.1Major depressive disorder, single episode, moderate

F32.2Major depressive disorder, single episode, severe without psychotic features

F32.4Major depressive disorder, single episode, in partial remission

F32.5Major depressive disorder, single episode, in full remission

Includes

Official

single episode of agitated depression
single episode of depressive reaction
single episode of major depression
single episode of psychogenic depression
single episode of reactive depression

Excludes 1

Official

bipolar disorder (F31.-)
manic episode (F30.-)
recurrent depressive disorder (F33.-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F32.3 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F32.3 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F32.3 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Missing subtle psychotic features such as nihilistic delusions or somatic delusions embedded in depressive narrative

Confusing psychotic depression with schizoaffective disorder — in psychotic depression, psychosis is limited to mood episodes

Using recurrent codes when this is a verified first episode

Not documenting the type of psychotic features present

Common Mistakes

HCC Buddy guidance

F32.2 — Major depressive disorder, single episode, severe without psychotic features: No psychosis

F33.3 — Major depressive disorder, recurrent, severe with psychotic features: Prior depressive episodes

F31.5 — Bipolar disorder, depressed, severe with psychotic features: Bipolar history present

F25.1 — Schizoaffective disorder, depressive 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 F32.3 an HCC code?

Yes. F32.3 (Major depressive disorder, single episode, 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: F32.3 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: F32.3
Description: Major depressive disorder, single episode, 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 132, Major Depressive Disorder and Other Mood Disorders

0.070

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 F32.3 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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

MDD, single episode, severe with psychotic features, requires documentation of psychotic features (delusions, hallucinations) in the context of the depressive episode. Specific to single-episode MDD. 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

•MDD, single episode, severe with psychotic features, requires documentation of psychotic features (delusions, hallucinations) in the context of the depressive episode. Specific to single-episode MDD.
•Psychotic features must be attributed to the MDD, not to a primary psychotic disorder (F20-F29). If schizophrenia or schizoaffective disorder is documented, those codes take precedence.
•V28 HCC 152 (Psychosis, Except Schizophrenia) at RAF 0.484. MDD with psychotic features maps to the psychosis HCC, which outweighs and supersedes the moderate/severe depression HCC 155.

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

Commonly Confused Codes

•F32.2: Major depressive disorder, single episode, severe without psychotic features: No psychosis
•F33.3: Major depressive disorder, recurrent, severe with psychotic features: Prior depressive episodes
•F31.5: Bipolar disorder, depressed, severe with psychotic features: Bipolar history present
•F25.1: Schizoaffective disorder, depressive type: Psychosis persists between mood episodes