F33.3 ICD-10-CM Code: Major depressive disorder, recurrent, severe with psychotic symptoms
F33.3 maps to CMS-HCC V28 152. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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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 guidanceMajor 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
MappedHCC 152
Coefficient HCC 152: 0.484 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
Context neededHCC 088
Coefficient needs member context
ESRD/PACE
Context neededHCC 59
Coefficient needs member context
RXHCC
MappedHCC 132
Code-level coefficient reference
Code Book Path
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
- Recurrent severe episodes of psychogenic depressive psychosis
- Recurrent severe episodes of psychotic depression
- Recurrent severe episodes of reactive depressive psychosis
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99, F33
- recurrent episodes of depressive reactionInherited from F01-F99, F33
- recurrent episodes of endogenous depressionInherited from F01-F99, F33
- recurrent episodes of major depressionInherited from F01-F99, F33
- recurrent episodes of psychogenic depressionInherited from F01-F99, F33
- recurrent episodes of reactive depressionInherited from F01-F99, F33
- recurrent episodes of seasonal affective disorderInherited from F01-F99, F33
- recurrent episodes of seasonal depressive disorderInherited from F01-F99, F33
- recurrent episodes of vital depressionInherited from F01-F99, F33
Excludes 1
Official- bipolar disorder (F31.-)Inherited from F33
- manic episode (F30.-)Inherited from F33
Code First
OfficialNo Code First sequencing instructions are included in this display for F33.3. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F33.3. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F33.3. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 HCC 152, Psychosis, Except Schizophrenia under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.484. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. 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 reference coefficient
- 0.484
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work F33.3 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F33.3
For F33.3, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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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 source-labeled community, non-dual, aged reference coefficient of 0.484. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
MDD, recurrent, severe with psychotic features, requires recurrent MDD history plus current severe episode with documented psychotic symptoms attributed to the depression. For F33.3, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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.
- •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