F33.3
BillableMajor depressive disorder, recurrent, severe with psychotic symptoms
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F33.3 an HCC code?
Yes. F33.3 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 F33.3
For F33.3 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 F33.3 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F33.3 is the ICD-10-CM diagnosis code for major depressive disorder, recurrent, severe with psychotic symptoms. Multiple episodes of severe depression with hallucinations or delusions (false beliefs or perceptions) occurring during depressive episodes. F33.3 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, F33.3 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, F33.3 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.
Clearly document the presence of psychotic symptoms and their relationship to the depressive episode. Because F33.3 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 F33.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Clearly document the presence of psychotic symptoms and their relationship to the depressive episode
- •Specify whether psychotic features are mood-congruent (consistent with depressed mood) or mood-incongruent
Clinical Significance
Major depressive disorder, recurrent, severe with psychotic symptoms represents the most acute form of recurrent depression, combining severe depressive symptoms with psychotic features. This is a high-acuity psychiatric condition that typically requires inpatient hospitalization, dual pharmacotherapy with antidepressants and antipsychotics, and sometimes electroconvulsive therapy. The recurrent pattern with psychotic features indicates a particularly treatment-resistant trajectory.
Documentation Requirements
- ✓Provider documentation of recurrent major depressive disorder
- ✓History of at least two separate major depressive episodes
- ✓Current episode documented as severe
- ✓Specific psychotic features documented: delusions (guilt, nihilistic, somatic) and/or hallucinations
- ✓Mental status examination documenting psychotic findings
- ✓Suicide risk assessment
- ✓Antipsychotic medication prescribed alongside antidepressant
- ✓Hospitalization documentation if applicable
Commonly Confused Codes
- •F33.2 — Major depressive disorder, recurrent, severe without psychotic features: No psychotic symptoms
- •F32.3 — Major depressive disorder, single episode, severe with psychotic features: First episode only
- •F31.5 — Bipolar disorder, depressed, severe with psychotic features: Bipolar history present
- •F25.1 — Schizoaffective disorder, depressive type: Psychosis persists between mood episodes