F48.1
BillableDepersonalization-derealization syndrome
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F48.1 an HCC code?
Yes. F48.1 maps to Personality Disorders and Dissociative Disorders under the CMS-HCC V28 risk adjustment model (and Personality 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 F48.1
For F48.1 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 F48.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F48.1 is the ICD-10-CM diagnosis code for depersonalization-derealization syndrome. A condition where a person experiences persistent feelings of detachment from their body, thoughts, or surroundings, or feels that the world around them is unreal or dreamlike. F48.1 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).
Under the CMS-HCC V28 risk adjustment model, F48.1 maps to Personality Disorders and Dissociative Disorders (HCC 153) with a community, non-dual, aged base RAF weight of 1.241. Under the older CMS-HCC V24 model, F48.1 maps to Personality Disorders (HCC 60) with a community, non-dual, aged base RAF weight of 0.000. 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.
Document whether depersonalization (detachment from self) or derealization (detachment from environment) predominates. Because F48.1 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 F48.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether depersonalization (detachment from self) or derealization (detachment from environment) predominates
- •Ensure symptoms cause significant distress or functional impairment
Clinical Significance
Depersonalization-derealization syndrome involves persistent or recurrent experiences of feeling detached from one's mental processes or body (depersonalization) and/or feeling that surroundings are unreal (derealization). This condition causes significant functional impairment and psychiatric distress. It maps to HCC categories across multiple models, making it important for risk adjustment capture.
Documentation Requirements
- ✓Documentation of persistent or recurrent depersonalization (feeling detached from self) and/or derealization (surroundings feel unreal)
- ✓Intact reality testing during episodes — patient knows the experience is not real
- ✓Significant distress or functional impairment from the symptoms
- ✓Symptoms not occurring exclusively during another mental disorder (schizophrenia, panic disorder, PTSD)
- ✓Symptoms not attributable to substance use or medical condition