F84.0 ICD-10-CM Code: Autistic disorder
HCC Buddy Code Card
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Pervasive and specific developmental disorders (F80-F89)
F84.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAutistic disorder
Autism spectrum disorder characterized by persistent difficulties in social communication and restricted, repetitive patterns of behavior, interests, or activities that begin in early childhood.
Buddy Insight
Autistic disorder (autism spectrum disorder, classic autism) is a neurodevelopmental condition characterized by persistent deficits in social communication and social interaction across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 133
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Autism spectrum disorder
- Infantile autism
- Infantile psychosis
- Kanner's syndrome
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for F84.0 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F84.0 in this effective period.
Excludes 1
Official- Asperger's syndrome (F84.5)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F84.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F84.0 in this effective period.
Code Also
Official- any associated medical condition and intellectual disabilities
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F84.0 an HCC code?
No. F84.0 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 F84.0
For F84.0to 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 F84.0 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
F84.0 is the ICD-10-CM diagnosis code for autistic disorder. Autism spectrum disorder characterized by persistent difficulties in social communication and restricted, repetitive patterns of behavior, interests, or activities that begin in early childhood. F84.0 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering pervasive and specific developmental disorders (f80-f89).
F84.0 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.
F84.0 does not map to any HCC in V28 or V24 models and has no RAF score impact for Medicare Advantage. RxHCC maps to 133 (0.000). Despite no risk adjustment impact, accurate coding is critical for service authorization and care coordination.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F84.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify the severity level (level 1, 2, or 3) if documented in the assessment
- •Document whether intellectual disability or language disorder is present, as these are coded separately
Clinical Significance
Autistic disorder (autism spectrum disorder, classic autism) is a neurodevelopmental condition characterized by persistent deficits in social communication and social interaction across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities. It is associated with significant healthcare utilization including behavioral therapy, speech therapy, occupational therapy, and management of comorbid conditions. Accurate coding supports appropriate service allocation.
Documentation Requirements
- ✓Provider documentation of autism spectrum disorder or autistic disorder diagnosis
- ✓Evidence of persistent deficits in social communication and social interaction across multiple contexts
- ✓Evidence of restricted, repetitive patterns of behavior, interests, or activities
- ✓Documentation that symptoms were present in the early developmental period (even if not fully recognized until later)
- ✓Current functional assessment and treatment plan including behavioral interventions
Excludes 1, Do NOT code together
- Asperger's syndrome (F84.5)
Commonly Confused Codes
- •F84.5: Asperger's syndrome; Asperger's historically lacked significant language delay and has a separate code, though DSM-5 merged it into ASD
- •F84.9: Pervasive developmental disorder, unspecified; use F84.0 when autistic disorder/ASD is specifically documented
- •F84.8: Other pervasive developmental disorders; for presentations that don't fully meet autism criteria
- •F80.x: Specific developmental disorders of speech and language; language delays alone are not autism