Yes. F33.3 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. F33.3 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.

Which HCC does F33.3 map to under V28?

F33.3 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 F33.3 pay in RAF?

F33.3 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 F33.3?

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 F33.3, 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 documentation supports F33.3?

MDD, recurrent, severe with psychotic features, requires recurrent MDD history plus current severe episode with documented psychotic symptoms attributed to the depression. Distinguish from F25.* (schizoaffective). If the psychotic features persist beyond the mood episodes, the correct family is schizoaffective, not recurrent MDD with psychosis. V28 HCC 152 (Psychosis, Except Schizophrenia) at RAF 0.484. Recurrent MDD with psychotic features maps to the psychosis HCC, which supersedes the depression HCC 155. Because F33.3 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. 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 F33.3: Major depressive disorder

F33.3 maps to CMS-HCC V28 152 (RAF 0.484). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF33.3Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

F33.3

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

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.

Buddy Insight

Major depressive disorder, recurrent, severe with psychotic symptoms represents the most acute form of recurrent depression, combining severe depressive symptoms with psychotic features.

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

F33Major depressive disorder, recurrent

F33.3Major depressive disorder, recurrent, severe with psychotic symptoms

Inclusion Terms

Official

Endogenous depression with psychotic symptoms
Major depressive disorder, recurrent, with psychotic features
Recurrent severe episodes of major depression with mood-congruent psychotic symptoms
Recurrent severe episodes of major depression with mood-incongruent psychotic symptoms
Recurrent severe episodes of major depression with psychotic symptoms

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F33.3 in this effective period.

Related Child Codes

Official

F33.0Major depressive disorder, recurrent, mild

F33.1Major depressive disorder, recurrent, moderate

F33.2Major depressive disorder, recurrent severe without psychotic features

F33.4Major depressive disorder, recurrent, in remission

F33.8Other recurrent depressive disorders

Includes

Official

recurrent episodes of depressive reaction
recurrent episodes of endogenous depression
recurrent episodes of major depression
recurrent episodes of psychogenic depression
recurrent episodes of reactive depression

Excludes 1

Official

bipolar disorder (F31.-)
manic episode (F30.-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F33.3 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F33.3 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F33.3 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Missing mood-congruent psychotic features during severe depressive episodes

Confusing psychotic depression with schizoaffective disorder

Coding as single episode with psychosis when prior episodes are documented

Not requiring both documentation of psychotic features AND severe depression simultaneously

Common Mistakes

HCC Buddy guidance

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

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 F33.3 an HCC code?

Yes. F33.3 (Major depressive disorder, recurrent, severe with psychotic symptoms) 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: F33.3 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: F33.3
Description: Major depressive disorder, recurrent, severe with psychotic symptoms
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 F33.3 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

Get the V28 RAF + MEAT cheat sheet

One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.

Free PDF. No card. Unsubscribe anytime.

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

MDD, recurrent, severe with psychotic features, requires recurrent MDD history plus current severe episode with documented psychotic symptoms attributed to the depression. 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

•MDD, recurrent, severe with psychotic features, requires recurrent MDD history plus current severe episode with documented psychotic symptoms attributed to the depression.
•Distinguish from F25.* (schizoaffective). If the psychotic features persist beyond the mood episodes, the correct family is schizoaffective, not recurrent MDD with psychosis.
•V28 HCC 152 (Psychosis, Except Schizophrenia) at RAF 0.484. Recurrent MDD with psychotic features maps to the psychosis HCC, which supersedes the depression HCC 155.

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