What is ICD-10 code F43.12?

F43.12 is the ICD-10-CM diagnosis code for Post-traumatic stress disorder, chronic. Post-traumatic stress disorder that persists for more than 3 months after a traumatic event, with ongoing symptoms of re-experiencing, avoidance, and hyperarousal. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F43.12 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F43.12 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. F43.12 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. F43.12 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 F43.12?

F43.12 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards F43.12 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

What should coders know when reporting F43.12?

Document that symptoms have been present for longer than 3 months to justify chronic coding Include the date of the traumatic event and current symptom status in the medical record

F43.12: Post-traumatic stress disorder, chronic — ICD-10

ICD-10-CM Code View

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Code lookupF43.12Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48)

F43.12

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

Post-traumatic stress disorder, chronic

Post-traumatic stress disorder that persists for more than 3 months after a traumatic event, with ongoing symptoms of re-experiencing, avoidance, and hyperarousal.

Buddy Insight

Post-traumatic stress disorder, chronic, indicates PTSD symptoms persisting for 3 months or longer.

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Not risk-adjusted for this model/period.

RAF 0

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Not risk-adjusted for this model/period.

RAF 0

RXHCC

Mapped

HCC 133

Personality Disorders, Anxiet...

RAF 0.0

Code Trumping

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Code Book Path

Official

F43Reaction to severe stress, and adjustment disorders

F43.1Post-traumatic stress disorder (PTSD)

F43.12Post-traumatic stress disorder, chronic

Inclusion Terms

Official

Traumatic neurosis

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F43.12 in this effective period.

Related Child Codes

Official

F43.10Post-traumatic stress disorder, unspecified

F43.11Post-traumatic stress disorder, acute

Includes

Official

ICD-10-CM does not list Includes notes for F43.12 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F43.12 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F43.12 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F43.12 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F43.12 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documented exposure to a qualifying traumatic event

All four PTSD symptom clusters present and documented

Duration of symptoms 3 months or longer

Assessment of comorbid conditions (depression, substance use disorders, chronic pain)

MEAT Support

HCC Buddy guidance

Documented exposure to a qualifying traumatic event

All four PTSD symptom clusters present and documented

Duration of symptoms 3 months or longer

Assessment of comorbid conditions (depression, substance use disorders, chronic pain)

Audit Caution

HCC Buddy guidance

Using the unspecified F43.10 when documentation clearly supports chronic PTSD

Not recognizing that 'complex PTSD' does not have a separate ICD-10-CM code — it is coded as F43.12 with additional codes for comorbid features

Failing to code comorbid conditions that commonly accompany chronic PTSD

Not documenting the duration threshold that distinguishes chronic from acute PTSD

Common Mistakes

HCC Buddy guidance

F43.11 (Post-traumatic stress disorder, acute) — Acute PTSD is less than 3 months; chronic is 3+ months

F43.10 (Post-traumatic stress disorder, unspecified) — Use F43.12 when chronicity is documented

F62.0 (Enduring personality change after catastrophic experience) — This represents a personality change following extreme trauma, distinct from PTSD

F33.1 (Major depressive disorder, recurrent episode, moderate) — Comorbid depression should be coded separately from PTSD

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is F43.12 an HCC code?

No. F43.12 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

HCC Category Mapping

RxHCCHCC 133, Personality Disorders, Anxiety, and Other Specified Mental Disorders

0.000

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.

Work F43.12 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for F43.12

For F43.12to 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 F43.12 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F43.12 is the ICD-10-CM diagnosis code for post-traumatic stress disorder, chronic. Post-traumatic stress disorder that persists for more than 3 months after a traumatic event, with ongoing symptoms of re-experiencing, avoidance, and hyperarousal. F43.12 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (f40-f48).

F43.12 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing F43.12 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F43.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document that symptoms have been present for longer than 3 months to justify chronic coding
•Include the date of the traumatic event and current symptom status in the medical record

Clinical Significance

Post-traumatic stress disorder, chronic, indicates PTSD symptoms persisting for 3 months or longer. Chronic PTSD often represents a more treatment-resistant course and is associated with greater functional impairment, higher rates of comorbid conditions (depression, substance use, chronic pain), and increased healthcare utilization. Despite its clinical severity, it does not map to any HCC.

Documentation Requirements

✓Documented exposure to a qualifying traumatic event
✓All four PTSD symptom clusters present and documented
✓Duration of symptoms 3 months or longer
✓Assessment of comorbid conditions (depression, substance use disorders, chronic pain)
✓Functional impairment across multiple life domains
✓Current treatment plan including trauma-focused therapy and/or pharmacotherapy
✓Documentation of treatment history and response

Commonly Confused Codes

•F43.11 (Post-traumatic stress disorder, acute): Acute PTSD is less than 3 months; chronic is 3+ months
•F43.10 (Post-traumatic stress disorder, unspecified): Use F43.12 when chronicity is documented
•F62.0 (Enduring personality change after catastrophic experience): This represents a personality change following extreme trauma, distinct from PTSD
•F33.1 (Major depressive disorder, recurrent episode, moderate): Comorbid depression should be coded separately from PTSD