F71
BillableModerate intellectual disabilities
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F71 an HCC code?
No. F71 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 F71
For F71to 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 F71 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F71 is the ICD-10-CM diagnosis code for moderate intellectual disabilities. Moderate intellectual disability refers to a significant limitation in intellectual functioning and adaptive behaviors that develops during childhood, resulting in a person needing substantial support in daily living skills, communication, and self-care. Individuals with this condition typically have an IQ between 35-49 and require ongoing assistance with education, employment, and independent living. F71 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering intellectual disabilities (f70-f79).
F71 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.
F71 does not map to any HCC in V28 or V24 models. RxHCC maps to RxHCC 147 (0.000 weight). No direct RAF score impact. Proper coding is important for care management and identifying patients needing supervised living and healthcare support.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F71 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •F71 is used for individuals with moderate intellectual disability; ensure documentation specifies the severity level to distinguish from mild (F70) or severe (F72) intellectual disabilities
- •This code should be accompanied by documentation of adaptive functioning deficits and typically requires supporting assessments or psychological evaluations in the medical record
Clinical Significance
Moderate intellectual disability represents an IQ range of approximately 35-49 and is characterized by slow language development, limited academic achievement, and the ability to learn basic self-care with moderate supervision. These individuals require consistent support in daily living and healthcare management. Comorbid conditions including epilepsy, behavioral disorders, and physical disabilities are common and add to care complexity.
Documentation Requirements
- ✓Provider documentation of intellectual disability with specification of severity as moderate
- ✓Formal cognitive testing (IQ approximately 35-49) or clinical assessment supporting moderate severity
- ✓Documentation of adaptive functioning deficits requiring moderate support in conceptual, social, and practical domains
- ✓Assessment of communication abilities and capacity for healthcare decision-making
- ✓Documentation of comorbid conditions, current living arrangement, and support services in place
Commonly Confused Codes
- •F70 — Mild intellectual disabilities; mild ID has higher functional capacity (IQ 50-69) with less intensive support needs
- •F72 — Severe intellectual disabilities; severe ID (IQ 20-34) requires extensive support beyond what moderate ID needs
- •F79 — Unspecified intellectual disabilities; use F71 when moderate severity is documented
- •F78.A1 — SYNGAP1-related intellectual disability; genetic-specific codes take precedence when the etiology is identified