F73
BillableProfound intellectual disabilities
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F73 an HCC code?
No. F73 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 F73
For F73to 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 F73 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F73 is the ICD-10-CM diagnosis code for profound intellectual disabilities. A developmental condition where a person has profound intellectual disability, the most severe level, meaning they have very limited intellectual functioning and require continuous, intensive support for all daily activities. F73 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering intellectual disabilities (f70-f79).
F73 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.
F73 does not map to any HCC in V28 or V24 models. RxHCC maps to RxHCC 146 (0.000 weight), same as severe ID. No direct RAF score contribution despite the extremely high care needs of this population. Coders reviewing F73 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-leverage RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F73 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation clearly establishes profound level with IQ testing and comprehensive adaptive functioning assessment
- •Document the need for 24/7 supervision and support for all activities of daily living
Clinical Significance
Profound intellectual disability represents an IQ below 20 with severely limited communication, mobility, and self-care abilities. These individuals require 24-hour support and are fully dependent on caregivers for all activities of daily living. They have the highest rates of comorbid medical conditions among intellectual disability groups, including epilepsy, sensory impairments, and physical disabilities. Healthcare requires specialized adaptive approaches.
Documentation Requirements
- ✓Provider documentation of intellectual disability with specification of severity as profound
- ✓Formal cognitive testing (IQ below 20) or clinical assessment supporting profound severity
- ✓Documentation of complete dependence on caregivers for all activities of daily living
- ✓Assessment of communication abilities (often nonverbal or preverbal)
- ✓Documentation of 24-hour care requirements, guardianship, and specialized support systems
Commonly Confused Codes
- •F72 — Severe intellectual disabilities; severe ID (IQ 20-34) retains some rudimentary self-care capacity unlike profound
- •F79 — Unspecified intellectual disabilities; profound severity must be specified when documented
- •G93.1 — Anoxic brain damage; acquired brain damage may cause profound cognitive deficits but is coded separately from developmental intellectual disability
- •R41.0 — Disorientation, unspecified; cognitive impairment codes are not substitutes for intellectual disability diagnosis