F54
BillablePsychological and behavioral factors associated with disorders or diseases classified elsewhere
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F54 an HCC code?
No. F54 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
F54 is the ICD-10-CM diagnosis code for psychological and behavioral factors associated with disorders or diseases classified elsewhere. A condition where psychological stress, emotional factors, or behavioral patterns are contributing to or worsening a physical medical condition. The psychological factors play a significant role in the disease process. F54 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering behavioral syndromes associated with physiological disturbances and physical factors (f50-f59).
F54 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 should be used in addition to the code for the underlying physical condition being affected.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F54 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code should be used in addition to the code for the underlying physical condition being affected
- •Ensure documentation clearly establishes the connection between the psychological/behavioral factors and the physical disorder
Excludes 2 — Not included here, may code separately
- tension-type headache (G44.2)